Pennsylvania Licensed Behavioral Health Director

Job Summary

Focusing on adult psychiatric cases related to substance abuse, the part-time Pennsylvania Licensed Behavioral Health Director will manage coverage reviews, clinical assessments, and provider engagement while working remotely for 20 hours per week from Tuesday to Friday during regular business hours in Eastern Standard Time.

Key responsibilities

• Conduct coverage reviews based on individual member plan benefits and proprietary review policies, rendering coverage determinations accordingly
• Document clinical review findings and ensure compliance with policies and regulatory standards
• Engage with providers through peer-to-peer discussions and support organizational accreditation efforts across various programs

Required qualifications

• 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