At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

This Position Is A Board Certified Psychiatrist Responsible For Medical Necessity Determinations With Respect To Behavioral Health Disorders At All Levels Of Care Which Includes Telephonic Peer-To-Peer (Physician To Physician) Reviews And Telephone Reviews With Facility Ur Personnel. Additional Duties Include: Review Of "Cases" With Care Management Professional Staff (Case Consultation). Review Of Medical Records; Participation In Committees. Representing The Department With Internal And External Key Stakeholders Such As Providers, Regulatory Bodies, Members And Customers. Directing The Inclusion Of Behavioral Health Expertise At All Levels Of The Program And Throughout The Enterprise, As Well This position is a board-certified psychiatrist responsible for medical necessity determinations with respect to behavioral health disorders at all levels of care which includes telephonic peer-to-peer (physician to physician) reviews and telephone reviews with facility UR personnel. Additional duties include review of "cases" with care management professional staff (case consultation). Review of medical records; participation in committees. Representing the department with internal and external key stakeholders such as providers, regulatory bodies, members and customers. Directing the inclusion of behavioral health expertise at all levels of the program and throughout the enterprise, as well as external to HCSC. Accountability for establishing and meeting utilization goals; and other duties as assigned.

Required Job Qualifications:

• Physician (M.D. or D.O) with a current and unrestricted physician license in a state or territory of the United States
• Maintain Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of Osteopathic Specialists
• Board certified in psychiatry in good standing.
• 5 years clinical experience in behavioral health care management.
• Located in a state or territory of the United States when conducting peer clinical reviews.
• Knowledge of state and federal health insurance regulations.
• Leadership skills.
• Verbal and written communications skills to include delivering presentations to committees and acting as company representative to key stakeholders including providers, regulatory bodies, etc.
• PC experience to include Microsoft Office suite of applications (Word, Excel, and PowerPoint) and databases.
• Ability and willingness to travel, including overnight stays (approximately 15% overnight travel).

Preferred Job Qualifications:

• 1 year behavioral health experience in a managed care environment.
• Experience conducting medical necessity reviews and applying NCQA standards and URAC requirements.
• Experience directing the work of other behavioral health providers, especially in the area of medical necessity determination.
• Project management and/or committee experience including leading projects

This is a Telecommute (Remote) role: Must reside withing 250 miles of the office or anywhere within the posted state.

Compensation: $187,700.00 - $348,600.00

Exact compensation may vary based on skills, experience, and location

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards