New

Medical Dir Behavioral Hlth

Health Care Service Corporation
life insurance, parental leave, paid time off, paid holidays, tuition reimbursement, 401(k)
United States, Illinois, Chicago
300 East Randolph Street (Show on map)
Sep 06, 2025
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. Job Summary 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. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan. 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. Base Pay Range$187,700.00 - $348,600.00 Exact compensation may vary based on skills, experience, and location.