Pennsylvania Licensed Behavioral Health Medical Director

Job Summary

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

Key responsibilities:

• Conduct coverage reviews and render determinations based on individual member plan benefits and review policies
• 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

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