Behavioral Health UM Director (Psychiatrist)

Medasource; Illinois; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading health insurance company is seeking a remote Psychiatrist Medical Director to assist with Utilization Review responsibilities. The role focuses on inpatient and case management reviews, serving DSNIP members. Ideal candidates are board certified psychiatrists with experience using Milliman and MCG guidelines.

Qualifications

• Must be a board certified Psychiatrist with an active license in your current state of residence.
• Experience with Milliman and MCG guidelines is preferred.

Responsibilities

• Conduct inpatient reviews and case management reviews.
• Perform out of network reviews based on client appeals and provider disputes.

Skills

Utilization Management

Case Management

Behavioral Health

Milliman guidelines

MCG guidelines

Education

Board certified Psychiatrist

Job description

Company : Large Health Insurance Company

Location : 100% Remote

Duration : 3–6 month contract

Start Date : ASAP

Summary :

Our large payer client is seeking a Psychiatrist Medical Director, Utilization Review (Behavioral Health) to join their team to assist with UM work on a per diem basis. Duties includes inpatient reviews, case management reviews, and out of network reviews based on the clients appeals & provider disputes.

Qualifications & Overview of Duties :

• Board certified Psychiatrist with an active license in your current state of residence.
• Experience working with Milliman (MCG) guidelines preferred.
• 90% of the work is on this side using Milliman (inpatient), 10% of the work will be focused within Concurrent Reviews using MCG guidelines
• Targeted case management reviews for state of FL for DSNIP members
• Out of network reviews & TCM – 10% of all cases

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