Washington Licensed Assistant Medical Director

Job Summary

Providing benefit coverage determinations based on medical necessity and contract language, the part-time Washington Licensed Assistant Medical Director will perform clinical reviews of behavioral health services, support peer-to-peer discussions regarding denial determinations, and participate in the development of medical review criteria.

Key responsibilities

• Conduct clinical reviews of various case types, including pre-service and post-service behavioral health services
• Engage in peer-to-peer discussions with external physicians regarding denial determinations and gather additional clinical history
• Collaborate with nursing and clinical staff to assess care options and support member and provider appeals

Required qualifications

• Licensed Physician with an MD or DO degree
• Unrestricted Washington MD or Alaska DO state licensure, or ability to obtain within 90 days
• Current board certification in psychiatry from the American Board of Psychiatry and Neurology
• Five years of clinical experience in psychiatry
• Previous experience performing medical necessity and clinical reviews in a health plan setting (preferred)