Behavioral Health Medical Director- Child Psychiatrist

Elevance Health•Denver, CO

47d•Remote

About The Position

Behavioral Health Medical Director- Child Psychiatrist Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered. Schedule: Fulltime position, Monday through Friday. The Behavioral Health Medical Director- Child Psychiatrist is responsible for completing medical necessity reviews for general child psychiatry cases as well as Applied Behavioral Analysis cases supporting commercial and Medicaid business lines. How you will make an impact: Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians. Applies clinical knowledge and skills to utilization review processes. Adheres to medical policies and clinical guidelines. As assigned, engage in clinical and non-clinical activities that impact health care quality cost and outcomes If requested, provides guidance for clinical operational aspects of a program. May be required to serve on internal and/or external committees. May develop and propose new medical policies based on changes in healthcare. As assigned, engage in clinical and non-clinical activities that impact health care quality cost and outcomes. Identifies and develops opportunities for innovation to increase effectiveness and quality.

Requirements

Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
Must possess an active unrestricted medical license to practice medicine or a health profession in the state of California.
Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.

Nice To Haves

Willing to obtain a California medical license.
Board Certified in Child & Adolescent psychiatry strongly preferred.

Responsibilities

Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.
Applies clinical knowledge and skills to utilization review processes.
Adheres to medical policies and clinical guidelines.
As assigned, engage in clinical and non-clinical activities that impact health care quality cost and outcomes
If requested, provides guidance for clinical operational aspects of a program.
May be required to serve on internal and/or external committees.
May develop and propose new medical policies based on changes in healthcare.
As assigned, engage in clinical and non-clinical activities that impact health care quality cost and outcomes.
Identifies and develops opportunities for innovation to increase effectiveness and quality.