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Associate Medical Director, Behavioral Health
Dane Street. Provide clinical oversight and subject matter expertise for behavioral health utilization review activities.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in behavioral health utilization review, including clinical oversight, quality management, and effective communication with stakeholders. Proficient in evaluating physician determinations and providing actionable feedback to enhance review processes.
Highest-signal resume keywords
MD Or DO With Board Certification In PsychiatryUtilization Review ExperienceASAM Criteria KnowledgeBehavioral Health Utilization Management CriteriaStrong Clinical Judgment
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Behavioral Health Utilization ReviewQuality ManagementClinical FeedbackLevel-Of-Care ReviewEvidence-Based Support
Soft Skills
Strong Written CommunicationStrong Verbal CommunicationIndependent WorkCoaching And Feedback
Tools & Technologies
LOCUSCALOCUSMCGInterQual
Certifications & Qualifications
Board Certification In PsychiatryChild And Adolescent Psychiatry CertificationActive Medical License
Industry Keywords
Behavioral HealthQuality ImprovementClient GrievancesPeer-To-Peer RequirementsHealth Plan
About the role
Key responsibilities & impact- Provide clinical oversight and subject matter expertise for behavioral health utilization review activities.
- Audit initial cases completed by newly onboarded behavioral health physician reviewers and provide feedback, coaching, or retraining when needed.
- Perform ongoing and targeted audits of behavioral health panelists based on quality trends, client grievances, overturn patterns, escalations, or other identified performance concerns.
- Review potential quality misses or inappropriate determinations and provide timely clinical feedback and remediation to physician reviewers.
- Support QA and operational staff with live case escalations involving behavioral health determinations, rationale quality, evidence-based support, peer-to-peer requirements, or reviewer performance.
- Monitor remediation effectiveness and provide follow-up guidance when quality concerns persist.
- Assist with behavioral health reviewer training and maintenance of reviewer training expectations and documentation.
- Participate in quality management and quality improvement activities related to behavioral health review services.
- Respond to client escalations or grievances involving behavioral health physician determinations and assist with root-cause review and remediation plans.
- Participate in client-facing calls, audits, and touch-base meetings as the behavioral health physician subject matter expert, including discussion of clinical quality, reviewer performance, and corrective actions.
- Participate in prospective client discussions as needed to provide physician perspective regarding behavioral health capabilities, panel oversight, and quality monitoring.
- Collaborate with Group Health leadership, Medical Director leadership, QA, operations, and physician network teams to support consistent, high-quality behavioral health utilization review.
Requirements
What you’ll need- MD or DO with board certification in Psychiatry; Child and Adolescent Psychiatry experience or certification preferred.
- Active, unrestricted medical license.
- Prior utilization review experience, preferably within a health plan, independent review organization (IRO), managed care, or similar environment.
- Demonstrated experience with ASAM Criteria and behavioral health medical necessity and level-of-care review.
- Working knowledge of behavioral health utilization management criteria and guidelines, including LOCUS/CALOCUS, MCG, and InterQual.
- Strong clinical judgment and ability to evaluate the quality, consistency, and defensibility of physician determinations and rationales.
- Strong written and verbal communication skills, including the ability to provide effective physician feedback and participate in client-facing discussions.
- Ability to work independently and respond promptly to time-sensitive clinical or quality escalations.