Guide Healthcare

Contract Behavioral Health Utilization Management Medical Director – Psychiatry

Guide Healthcare

part-time

Posted on:

Location Type: Remote

Location: Illinois • United States

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Job Level

Lead

About the role

  • Performing physician-level utilization management reviews for behavioral health services across all applicable levels of care, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient services
  • Rendering medical necessity determinations using Company-approved, evidence-based criteria (e.g., InterQual®, MCG®, or plan-specific guidelines)
  • Reviewing escalated, complex, and reconsideration cases, including first- and second-level appeals, as requested
  • Ensuring determinations are timely, clinically appropriate, and consistently applied across commercial product lines
  • Conducting peer-to-peer consultations with treating psychiatrists and other behavioral health providers
  • Communicating clear, clinically sound rationales for utilization management decisions
  • Supporting resolution of provider disputes related to medical necessity or level-of-care determinations
  • Applying utilization management criteria and processes in compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA)
  • Ensuring non-quantitative treatment limitations (NQTLs), including prior authorization requirements, review standards, and clinical criteria application, are comparable to and no more stringent than those applied to medical/surgical benefits
  • Supporting parity analyses, documentation, and regulatory inquiries as requested
  • Providing clinical input on parity-related policies, utilization management practices, and corrective action plans
  • Performing utilization management activities in alignment with NCQA Health Plan Accreditation standards
  • Supporting readiness for NCQA surveys, audits, and corrective actions related to behavioral health utilization management
  • Assisting with the development, review, or refinement of utilization management policies and procedures to maintain accreditation compliance
  • Serving as a consultative clinical resource to behavioral health utilization management nurses, care managers, and operational leaders
  • Providing recommendations to improve utilization management consistency, quality, efficiency, and provider experience
  • Participating in scheduled or ad hoc clinical, quality, or utilization review meetings as requested

Requirements

  • MD or DO with board certification or board eligibility in Psychiatry
  • Active, unrestricted Illinois medical license (required)
  • Minimum of 3 years of post-residency psychiatric practice
  • Prior experience in utilization management, managed care, or medical director roles
Benefits
  • Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
  • Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
  • Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
  • Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
  • Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
  • Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
  • Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
  • Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
utilization managementmedical necessity determinationspeer-to-peer consultationsclinical inputparity analysesNCQA Health Plan Accreditation standardsutilization management policiesevidence-based criteriafirst-level appealssecond-level appeals
Soft Skills
communicationclinical rationaleconsultative resourcerecommendations for improvementprovider dispute resolution
Certifications
MDDOboard certification in PsychiatryIllinois medical license