Assistant Medical Director - Behavioral Health Focus (Psychiatry)

Location: Telecommuter role; hiring is limited to listed U.S. states, including Washington and Alaska. The position is associated with Mountlake Terrace, Washington.

Salary: $214,500–$386,100 annually.

Company

hirify.global operates a health plan focused on improving healthcare outcomes and member experiences.

What you will do

• Perform pre-service, post-service, and concurrent clinical reviews of outpatient and facility-based behavioral health services.
• Make final coverage decisions based on medical necessity, medical policy criteria, member contracts, investigational status, exclusions, and network structure.
• Conduct peer-to-peer discussions with external physicians and providers and gather additional clinical information.
• Support clinical staff, member and provider appeals, secondary reviews, and care-option assessments.
• Participate in the development, annual review, and approval of medical review criteria and in inter-rater reliability evaluations.
• Respond to consultation requests and complete required continuing education and training.

Requirements

• Licensed physician with an MD or DO degree.
• Unrestricted Washington MD or Alaska DO licensure, or the ability to obtain it within 90 days.
• Current board certification in psychiatry from the American Board of Psychiatry and Neurology.
• At least five years of clinical psychiatry experience.
• Experience with medical necessity and clinical reviews in a health plan setting is preferred.
• Familiarity with MCG or InterQual criteria, CPT, ICD, HCPCS, and RBRVS pricing concepts is preferred.

Culture & Benefits

• Part-time schedule of 20 hours per week.
• Medical, vision, and dental coverage with low employee premiums.
• Life and disability insurance, retirement programs with a 401(k) match, and a pension plan vested after three years.
• Paid time off, wellness resources, counseling and mindfulness programs.
• Tuition assistance and employee recognition programs.