Contract Behavioral Health Utilization Management Medical Director (Psychiatry)

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.

What Youll Be Doing

Utilization Management & Medical Necessity Review

• 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

Peer-to-Peer & Provider Engagement

• 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

Mental Health Parity & Regulatory Compliance (MHPAEA)

• 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

Accreditation & Quality Support

• 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

Clinical Advisory & Program Support

• 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

Deliverables

Deliverables may include but are not limited to:

• 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

Qualifications :

What Youll Need for success

Required Qualifications

• 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

What Wed Love for You to Have

• 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

Engagement Details

• 1099 independent contractor engagement
• Part-time flexible schedule (approximately 6 hours per week)
• No minimum hours guaranteed
• Must maintain sufficient availability to meet regulatory and turnaround time requirements

Additional Information :

ALIVE with Purpose: How We Thrive at Guidehealth 

At Guidehealth our values come to life in everything we do. 

• We are Driven by Accountability grounded in transparency reliability and integrity as we navigate challenges and opportunities alike. 
• Always Growing Always Learning staying curious and continuously improving inspires us to shape a better future for healthcare. 
• With Collaborative Innovation we solve problems creatively making every experience better for our employees and the patients we serve. 
• At Guidehealth Every Voice Matters we believe our collective strength is rooted in the unique perspectives of each team member. 
• And through Empathy in Action we build stronger connections with those who count on us. 
• This is what it means to be ALIVE with purpose. This is how we thrive together at Guidehealth. 

BENEFITS:

While you are hard at work advancing value-based healthcare we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• 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.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include but are not limited to: skill set years of relevant experience education location and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity inclusion and belonging are at the core of Guidehealths values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race religious creed color age sex sexual orientation and identity national origin citizenship religion marital status familial status physical sensory or medical disability Family and Medical Leave military or veteran status pregnancy childbirth or other related medical conditions or any other classification protected by federal state and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring placement promotion transfer demotion layoff termination recruitment advertising pay and other forms of compensation training and general treatment during employment. 

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealths custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles the responsibilities would be further defined by the hiring manager. 

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements. 

Remote Work :

Yes

Employment Type :

Full-time