Contract Behavioral Health Utilization Management Medical Director (Psychiatry)

Guidehealth • Chicago, IL

6h • Remote

About The Position

Guidehealth is seeking a Behavioral Health Utilization Management Medical Director (Psychiatry) to serve as a part-time, 1099 consultant supporting utilization management activities for a commercial health plan. This role provides physician-level clinical review and consultative leadership across behavioral health services, ensuring medical necessity determinations are clinically sound, timely, and compliant with regulatory and accreditation standards. This opportunity is well suited for a psychiatrist with managed care or utilization management experience who is seeking flexible, non-clinical consulting work.

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

Nice To Haves

• Experience supporting commercial health plans
• Familiarity with behavioral health parity and accreditation standards (e.g., NCQA)
• Strong peer-to-peer communication and clinical documentation skills

Responsibilities

• 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
• Timely completion and documentation of assigned utilization management reviews and determinations
• Written clinical rationales supporting authorization, denial, or modification decisions
• Documentation supporting MHPAEA compliance and NCQA standards, as applicable
• Verbal or written recommendations related to utilization management process or policy improvements

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.

What This Job Offers

• Job Type: Part-time
• Career Level: Director
• Education Level: Ph.D. or professional degree