Physician Advisor (Psychiatrist)

Community Behavioral Health. • Philadelphia, PA

5h

About The Position

The Physician Advisor provides strategic oversight of medical necessity determinations for behavioral health services, ensuring alignment with clinical standards and organizational objectives. This role is accountable for conducting medical necessity and peer reviews, directing the activities of the crisis team, and fostering collaboration with clinical providers to promote high-quality, effective mental health care for CBH Members.

Requirements

• MD/DO from Accredited Medical School
• Current Board certification in Psychiatry and/or Child and Adolescent Psychiatry by the American Board of Psychiatry and Neurology
• Current and Active State of Pennsylvania Medical License
• Minimum of 5 years of clinical psychiatry experience including significant and specific experience with inpatient care and substance abuse treatment
• Ability to provide clinical oversight on a wide array of operational activities.
• Strategic planning
• Financial planning
• Excellent written and verbal communication skills
• Familiarity with medical assistance regulations and managed care principles and practices
• Knowledge of Managed Care Organization operations and principles.
• Demonstrated leadership ability.

Responsibilities

• Review cases from multiple sites and levels of care for medical necessity.
• Peer review cases for disputed levels of care.
• Perform medical reviews
• Make denial decisions based on medical necessity
• Participate in clinical and administrative meetings.
• Interact with providers on clinical and administrative matters.
• Serve as clinical leadership resource and consultant to Clinical Care Managers, offering guidance on complex cases and best practices.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree
• Number of Employees: 251-500 employees