Job Details

Job Description:
A reputable organization is seeking a dedicated Behavioral Health Medical Director to focus primarily on adult psychiatric cases related to substance abuse. This part-time role offers a flexible schedule, with 20 hours per week spread across Tuesday through Friday during regular business hours in Eastern Standard Time. No weekend coverage is required. The Medical Director will review 12-15 cases during each 4-hour shift, ensuring accurate clinical assessments and coverage determinations in accordance with internal policies, regulatory standards, and accreditation requirements. This position involves interpreting benefit language, engaging with providers through peer-to-peer discussions and participating in organizational quality efforts.

Responsibilities:

• Conduct coverage reviews based on individual member plan benefits and national, as well as proprietary review policies. Render coverage determinations accordingly.

• Document clinical review findings, actions, and outcomes in compliance with policies and regulatory standards.

• Utilize Interqual and ASAM guidelines to inform review decisions.

• Engage with requesting providers through peer-to-peer discussions when necessary.

• Interpret existing benefit language and policies to support clinical coverage reviews.

• Collaborate and communicate with network and non-network providers to ensure timely and accurate benefit determinations, educating providers on benefit plans and medical policies.

• Make coverage determinations when requested services do not meet medical necessity criteria or benefit exclusions require medical evaluation.

• Perform assessment and decision-making on appeals and grievances, ensuring each review level is conducted by different reviewers.

• Support organizational accreditation efforts and regulatory review processes across various programs such as prior authorization, concurrent review and case management.

• Maintain current knowledge of emerging medical treatment modalities and standards such as those from the National Committee for Quality Assurance and URAC.

Requirements:

• 5+ years of clinical experience post-residency, including inpatient and outpatient care

• 3+ years of experience in managed care, utilization review or quality management

• MD or DO degree with appropriate Board certification

• Current unrestricted licensure in Pennsylvania as an MD or DO

• Current coverage, or eligibility for, medical liability insurance

Pay Range:
The anticipated pay range for this position is $120.00 - $150.00 per hour. We understand salary is an important factor in a job search, and we encourage you to apply even if you feel that your desired compensation may fall outside of the listed range. The final pay for this position is determined based on several factors including but not limited to, relevant experience, skills and certifications, education and training, geographic location, market conditions, and internal equity. We are committed to finding the right candidate for this role and are open to discussing how your unique qualifications align with our needs.

Benefits:

• Medical insurance

• Dental insurance

• Vision insurance

• 401(k) retirement savings plan

Contact:
Karrie Ruch
kruch@jacobsongroup.com

Equal Opportunity Employer:
The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs.
If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at HR@jacobsongroup.com or +1 (800) 466-1578 to make a request.

Refer a Colleague:
Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!