Medical Director-Psychiatry

The Medical Director – Psychiatry will provide clinical leadership and expertise in utilization management, ensuring that healthcare services are medically necessary, evidence-based, and aligned with regulatory requirements. This role oversees prospective, concurrent, and retrospective medical reviews, prior authorizations, and complex clinical determinations. You will serve as a trusted clinical resource, engaging directly with practitioners through peer-to-peer discussions to explain decisions and explore appropriate care alternatives. Working closely with Nurse Practitioners, Care Coordinators, and Operations teams, you will help improve utilization management processes and member outcomes. You will also contribute to medical policy development, quality improvement initiatives, and clinical governance. This is a remote opportunity for a board-certified psychiatrist who enjoys combining clinical judgment with collaboration, adaptability, and hands-on contribution in a fast-growing healthcare environment.

The ideal candidate will be an experienced, board-certified psychiatrist with a strong background in clinical practice and healthcare utilization management. You should demonstrate sound medical judgment, excellent communication skills, and the ability to make complex clinical decisions while managing a high volume of cases in a remote environment. Required qualifications include:

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school.

• Board certification in Psychiatry.

• Active and unrestricted medical license in at least one U.S. state, with the ability to obtain additional state licenses as needed. Support for additional licensure will be provided.

• Minimum of 5 years of clinical practice experience.

• Minimum of 2–3 years of experience in utilization management, medical review, or prior authorization within an insurance or managed care organization.

• Demonstrated experience conducting peer-to-peer discussions with external practitioners.

• Strong understanding of medical necessity criteria, evidence-based medicine, and healthcare utilization management principles.

• Excellent analytical and critical-thinking skills, with the ability to assess complex clinical information and make sound medical decisions.

• Exceptional written and verbal communication skills, including the ability to explain complex medical determinations clearly and empathetically.

• Proficiency with electronic health record (EHR) systems and utilization management software.

• Strong organizational skills and the ability to manage a high volume of cases independently in a remote work environment.

• Self-motivated, adaptable, and comfortable working in a fast-paced, evolving organization.

• A proactive, hands-on approach and genuine enthusiasm for contributing to an innovative healthcare environment.