Job Description

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.

Schedule: 2-3 days per week (8:30a-5p), with on=call rotation (limited to emergent requests).

The Behavioral Health Medical Director (Child and Adolescent) serves as a physician leader responsible for promoting the delivery of safe and effective medical care in the most cost-effective way for the health plans offered by Independence Blue Cross and subsidiaries. There are multiple elements of discrete work that may fall under the role including:

Utilization Management

The physician directly supports Utilization Management and Care Management and other business activities where involvement of a physician is determined to be in the best interest of Independence. The Medical Director will be responsible for rendering coverage and payment determinations based on the terms and conditions of the health plans for which Independence serves as claims administrator, and on the terms and conditions of contracts executed between Independence and networks of participating health care providers.

A primary role of this physician is to render medical necessity decisions on requests handled by the Applied Behavior Analysis (ABA) program and to provide clinical leadership for the team's case management and care coordination functions.

The Medical Director will exercise sound decision making based on clinical guidelines for best practices, a strong knowledge of clinical medicine, the practical realities of the delivery of health care in the state of Pennsylvania, and a thorough understanding of the principles of population health, quality management, patient safety and health insurance. The Medical Director will be expected to effectively collaborate with professional staff, senior leadership, management and associates and with external partners to promote the delivery of cost-effective health care across all lines of business.

Required Qualifications and Experience:

• We require a Medical Doctor or Doctor of Osteopathy degree from a medical school or osteopathic medical school recognized by the American Association of Medical Colleges (AAMC), the American Osteopathic Association (AOA), or the World Health Organization (WHO).
• Has an unrestricted and unencumbered Pennsylvania license to practice clinical medicine or osteopathic medicine.
• Current Board Certification in in Child and Adolescent Psychiatry by the American Board of Neurology and Psychiatry
• Ability to successfully complete Independence Blue Cross credentialing process

Fully Remote:
This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

Job Tags

Part time, Work at office, Remote work, 2 days per week, 3 days per week,

Similar Jobs