Behavioral Health Medical Director-Psychiatrist Appeals 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. Alternate locations can be considered. 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. Work schedule: Monday – Friday. Half day Saturday rotation, once a month. The Medical Director is responsible for the administration of behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. How you will make an impact: Supports clinicians to ensure timely and consistent responses to members and providers. Provides guidance for clinical operational aspects of a program. Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. Serves as a resource and consultant to other areas of the company. May be required to represent the company to external entities and/or serve on internal and/or external committees. May chair company committees. Interprets medical policies and clinical guidelines. May develop and propose new medical policies based on changes in healthcare. Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. Identifies and develops opportunities for innovation to increase effectiveness and quality. Provides oversight, direction, and guidance to Medical Director Associates. Works independently with oversight from immediate manager. May be responsible for an entire clinical program and/or independently performs clinical reviews. Typically has program management responsibilities including clinical policy development, improvement of quality, cost, and outcomes, program development/implementation, and overseeing clinical/non-clinical activities.