Physician Reviewer (Medical Director) in Psychiatry

Description

Our Medical Directors leverages their medical experience and judgment to determine whether requested services, levels of care, and/or sites of service should be authorized. This role operates within a framework of criteria from the patient’s healthcare plan, regulatory compliance, and utilizing diverse resources such as national clinical guidelines, CMS policies, clinical reference materials, internal teaching conferences, and other references.

Adult AND Child & Adolescent Board Certification is required for this position.

Key Responsibilities

• Medical Decision Making: Review all submitted medical records and clinical scenarios to provide expert decisions on requested services.
• Communication: Engage in regular discussions with external providers via phone to gather additional clinical information and discuss determinations.
• Collaboration: Understand and navigate processes, fostering collaborative business relationships.
• Compliance and Support: Ensure that all services provided align with national guidelines, CMS requirements, URAC policies, clinical standards, and contractual obligations.

Ideal Candidate

• Current board certified in Child & Adolescent Psychiatry and Psychiatry, and willing to work case for all ages. 
• Willing and able to work the structured schedule: 40 hours per week, 5-8 hours per week, including weekend shifts. Work hours are between 6:00am – 7:00pm Mountain Time Zone.
• Integrity and Professionalism: Demonstrates a high degree of integrity and professionalism.
• Resourcefulness: Utilizes available resources effectively to make informed decisions.
• Team Collaboration: Supports and collaborates with team members, other departments, colleagues, and leadership.
• Independence and Structure: After completing structured and mentored training, performs daily tasks with minimal supervision but with ready support from team members. Enjoys working in a structured environment with consistent thinking and authorship.
• Compliance and Timeliness: Exercises independence in meeting departmental expectations and compliance timelines.

Requirements

To qualify for this position, you must meet the following requirements:

•    M.D. or D.O. Degree, with current board certification in Child & Adolescent Psychiatry and General Psychiatry.

•    5 years of recent direct patient care experience.

•    Be willing to obtain up to 20 additional state licenses (MRIoA will manage and cover the cost of licenses and CME requirements to maintain them).

•    You must have a clean background, without any prior licensure issues or malpractice history (background or malpractice issues can delay the process of obtaining additional licenses).

•    You must be fully committed to the job during your scheduled hours. This position does not allow for any caregiving or other responsibilities during your scheduled work hours.

·     You must reside and work within the United States. 

Physical Requirements: Must be able to sit at a desk and work on a computer for 8 hours daily.

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen and agree to all necessary Compliance Regulations on their first day of employment.