Assistant Medical Director – Behavioral Health Focus

Job not on LinkedIn

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🐻 Alaska, Washington – Remote

🐻 Alaska – Remote ☕ Washington – Remote

💵 $214.5k - $386.1k / year

⏱ Part Time

🔴 Lead

👨‍⚕️ Medical Director

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Premera Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1945

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Premera Blue Cross is an independent health insurance provider, serving businesses and residents of Washington State and Alaska as a licensee of the Blue Cross Blue Shield Association. The company offers a range of health plans including individual, family, employer-based, and Medicare Supplement plans. However, it has announced that it will exit the Medicare Advantage market as of January 1, 2025. Premera is committed to advancing health equity and community support, evident through its Social Impact Program focused on behavioral health and homelessness solutions in Washington and Alaska. Additionally, Premera complies with federal and state civil rights laws, offering language assistance services to ensure equitable care.

📋 Description

• Perform clinical review of pre-service, post-service, and concurrent behavioral health services • Review outpatient and facility-based behavioral health cases • Consult with clinical staff on specific case reviews • Make final coverage decisions based on medical necessity, investigational status, contractual exclusions, or network structure • Support peer-to-peer discussions with external physicians and providers regarding denial determinations • Collect additional clinical history relevant to case determinations • Consult with nursing and other clinical staff to assess and explore care options for members • Participate in development, annual review, and approval of company medical review criteria as a Premera Medical Policy Committee member • Participate in Inter-Rater Reliability evaluations • Respond to consultation requests from Premera Blue Cross and contracted practitioners and facilities • Support member and provider appeals and conduct secondary reviews as needed • Fulfill professional continuing education requirements and participate in ongoing education and training

🎯 Requirements

• Licensed Physician with an MD or DO degree (Required) • Unrestricted Washington MD or Alaska DO state licensure, or ability to obtain within 90 days • Current board certification in psychiatry from the American Board of Psychiatry and Neurology • Five (5) years of clinical experience in psychiatry (Required) • Previous experience performing medical necessity and clinical reviews in a health plan setting (Preferred) • Familiarity or experience with clinical criteria sets and clinical pathways, such as MCG (Milliman Care Guidelines) or InterQual (Preferred) • Familiarity or experience with CPT, ICD, and HCPCS code sets and resource-based relative value scale (RBRVS) pricing concepts (Preferred) • Part-time availability of 20 hours per week

🏖️ Benefits

• Medical, vision, and dental coverage with low employee premiums • Voluntary benefit offerings, including pet insurance • Life and disability insurance • Retirement programs, including a 401K employer match and a pension plan vested after 3 years of service • Wellness incentives, including mental well-being resources, counseling services, stress management programs, and mindfulness programs • Generous paid time off • Tuition assistance for undergraduate and graduate degrees • Employee recognition program • Flexibility for hybrid employees with access to on-site resources, networking opportunities, and team engagement • Commuter perks • Free convenient on-site parking • Subsidized on-campus cafes • On-site health and wellness activities • Fitness and well-being center with in-person and virtual workouts and nutritional counseling • Shuffleboard and ping pong on campus