MD – Behavioral Health Psychiatry

Horizon Connect @ Wall BCBSNJ

. Provide day-to-day guidance, support, and medical leadership for utilization management activities and decisions within Behavioral Health .

Posted 10/27/2026full-timeRemote • New Jersey • United StatesMid-LevelSenior💰 $214,100 - $297,885 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management principles and procedures, with a strong foundation in Behavioral Health treatment protocols and medical policy interpretation. Possesses extensive clinical experience and the ability to analyze data to inform decision-making and guide clinical reviewers.

Highest-signal resume keywords

Board Certification As An MD Or DOMinimum Five Years Clinical ExperienceThree Or More Years Medical Management ExperienceKnowledge Of Utilization Management PrinciplesStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ManagementMedical Necessity DecisionsData AnalysisClinical KnowledgeMedical Policy Interpretation

Soft Skills

Independent JudgmentAnalytical Skills

Certifications & Qualifications

Active Unrestricted NJ MD Or DO LicenseChild Psychology Board Eligible

Industry Keywords

Managed CareHealth Care Delivery SystemsURAC Health UM StandardsPeer ReviewHealth Insurance Payor Business

About the role

Key responsibilities & impact

Provide day-to-day guidance, support, and medical leadership for utilization management activities and decisions within Behavioral Health
Support the Medical Director—Behavioral Health in all aspects of utilization management
Provide medical expertise regarding health care delivery systems, utilization and reimbursement methods, and Behavioral Health treatment protocols
Support, guide, and consult with BH Clinician reviewers on pre-authorization, concurrent, and retrospective review issues or decisions
Support, guide, and consult with BH Clinician reviewers on case management issues or decisions
Support, guide, and consult with BH Clinician reviewers on medical necessity and medical appropriateness issues or decisions
Participate in development, planning, and management of complex cases and communicate management plans to providers
Guide staff in interpreting medical policy
Assist with medical policy and technology assessments and recommendations
Assist or consult on the appeal review process
Provide input to provider credentialing, profiling, communication initiatives, and network development as needed
Analyze data from various sources to identify trends and issues
Participate on internal or external committees as assigned

Requirements

What you’ll need

Board certification as an MD or DO
Current unrestricted license to practice medicine in one of the primary care specialties
Minimum of five years clinical experience
Three or more years medical management experience in a managed care setting
Completion of approved residency in Psychiatry
Completion of accredited Child and Adolescent Psychiatry Fellowship
Child Psychology Board eligible by start date
Active unrestricted NJ MD or DO license required for Government Programs
Knowledge of Utilization Management principles and procedures, URAC Health UM Standards, and peer review
Excellent understanding of managed care principles and concepts
Knowledge of the health insurance payor business, including operations
Broad clinical knowledge and understanding of current health care issues
Broad clinical skills for understanding and discussing medical issues with physicians
Ability to exercise independent judgment in making medical necessity decisions
Ability to interpret and apply medical policy and provide guidance to others
Strong communication skills
Analytical skills to evaluate data from various sources and identify trends and issues

Benefits

Comp & perks

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement