MD – Behavioral Health Psychiatry

Job not on LinkedIn

🕒 October 27

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $214.1k - $297.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 16%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Horizon Connect @ Wall BCBSNJ

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2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Provide day-to-day guidance, support, and medical leadership for utilization management activities and decisions within Behavioral Health • Support the Medical Director—Behavioral Health in all aspects of utilization management • Provide medical expertise regarding health care delivery systems, utilization and reimbursement methods, and Behavioral Health treatment protocols • Support, guide, and consult with BH Clinician reviewers on pre-authorization, concurrent, and retrospective review issues or decisions • Support, guide, and consult with BH Clinician reviewers on case management issues or decisions • Support, guide, and consult with BH Clinician reviewers on medical necessity and medical appropriateness issues or decisions • Participate in development, planning, and management of complex cases and communicate management plans to providers • Guide staff in interpreting medical policy • Assist with medical policy and technology assessments and recommendations • Assist or consult on the appeal review process • Provide input to provider credentialing, profiling, communication initiatives, and network development as needed • Analyze data from various sources to identify trends and issues • Participate on internal or external committees as assigned

🎯 Requirements

• Board certification as an MD or DO • Current unrestricted license to practice medicine in one of the primary care specialties • Minimum of five years clinical experience • Three or more years medical management experience in a managed care setting • Completion of approved residency in Psychiatry • Completion of accredited Child and Adolescent Psychiatry Fellowship • Child Psychology Board eligible by start date • Active unrestricted NJ MD or DO license required for Government Programs • Knowledge of Utilization Management principles and procedures, URAC Health UM Standards, and peer review • Excellent understanding of managed care principles and concepts • Knowledge of the health insurance payor business, including operations • Broad clinical knowledge and understanding of current health care issues • Broad clinical skills for understanding and discussing medical issues with physicians • Ability to exercise independent judgment in making medical necessity decisions • Ability to interpret and apply medical policy and provide guidance to others • Strong communication skills • Analytical skills to evaluate data from various sources and identify trends and issues

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement

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