99 applicants

Company

Clearlink Partners · 5 hours ago

Psychiatrist (Licensed in NY)

United States

Part-time

Remote

Mid, Senior Level

3+ years exp

Maximize your interview chances

Health Care

Insider Connection @Clearlink Partners

Discover valuable connections within the company who might provide insights and potential referrals.
Get 3x more responses when you reach out via email instead of LinkedIn.

Responsibilities

Conduct utilization reviews and assess medical necessity, appropriateness, and cost-effectiveness of behavioral health and addiction treatment services.

Provide clinical consultations and case reviews with care management teams and external providers regarding treatment plans, care options, and discharge planning.

Serve as a clinical resource for behavioral health staff, offering guidance on complex addiction cases and co-occurring mental health conditions.

Ensure that treatment recommendations align with evidence-based practices and addiction medicine guidelines.

Maintain up-to-date knowledge of best practices in addiction medicine, psychiatry, and managed care policies.

Track and analyze clinical trends, supporting the development of care strategies to improve behavioral health outcomes and manage associated healthcare costs.

Assisting with writing/reviewing Behavioral Health policies and clinical guidelines

Conduct training sessions for care managers, peer reviewers, and other staff on best practices in addiction medicine and utilization management.

Serve as a thought leader in behavioral and addiction psychiatry, representing the organization in internal and external educational activities, seminars, and conferences.

Provide strategic direction for health plan market/product medical management and health service operational oversight, management and performance.

Leverage advanced industry expertise and expert knowledge, grounded in research and industry best practice, to provide high value consulting and advisory services.

Deliver innovative, integrated solutions in support of client goals and engagements.

Lead engagements ensuring completion of all contracted services

Present findings, recommendations and plans to Client executives

Facilitate complicated problem-solving discussions to drive to timely, effective decision making

Advise and persuade key decision makers and influencers

Deliver concise, clear interpersonal communication to both internal and external audiences

Facilitate streamlined executive summaries, next step recommendations and communication to all levels of Clearlink and client/partner organization(s)

Articulate performance across multiple projects with qualitative and quantitative results/outcomes

Influence others to best course of action through advanced understanding of changing business landscapes

Develop strategies, goals and plans in response to changing business conditions

Leverage best practice methodologies and approaches across individual account strategies/client plans.

Establish short term KPIs and long-term goals and track progress to ensure achievement

Develop or update policies, procedures and workflows as required to support business needs and requirements

Coach and mentor staff to reach established engagement goals, plan deliverables and KPIs

Adapt process, approach, plan and/or activities in real time to mitigate risk and ensure critical path activities

Support account management relationships with key client decision makers

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Managed care expertiseMedical Degree MDMedical Degree DOBoard-certified in PsychiatryAddiction Medicine certificationClinical experienceAddiction treatment modalitiesUtilization managementMedical necessity criteriaHigh proficiency in ExcelHealthcare administration knowledgeProject management principlesC-Suite experienceStrategic leadershipEducation skillsRegulatory compliance knowledgeHealthcare consulting experienceBehavioral health program managementMentoring skills

Required

Medical Degree (MD or DO) required; Must be actively licensed in the state of New York.

Board-certified in Psychiatry with a subspecialty certification in Addiction Medicine required.

Minimum of 3 years of clinical experience in managed care behavioral health program management with addiction psychiatry and behavioral health utilization management, claims review, appeals and denials experience strongly preferred.

In-depth knowledge of addiction treatment modalities and recovery-oriented care approaches.

Familiarity with managed care principles, medical necessity criteria (e.g., ASAM, MCG), and utilization review processes.

10+ years administrative leadership achievement in health plan operations with progressive responsibility.

7+ years of experience in a government payor environment with expertise in medical management practice with experience in multiple lines of business (Medicare, Medicaid, Healthcare Exchange, Commercial etc).

5+ years delivering results, managing teams and projects and mentoring other physicians in a health plan setting and/or consulting environment; driving complex, multi-faceted, multi-site, application/operational change/improvement programs and activities.

Advanced managed care industry expertise with C-Suite experience developing strategy, managing P&L, leading people, and ensuring contractual compliance.

Ability to translate trends, innovation, operations, financing, costs, requirements and performance into scalable activities and repeatable outcomes.

New product/market strategy, design and implementation in the Commercial, Medicare, Medicare Advantage, Medicaid and/or associated lines of business.

New population strategy development including identification, program design and implementation.

Operationalizing requirements for complex memberships, ensuring outcome delivery.

Expert understanding of legal and regulatory frameworks, healthcare administration models, and internal audit procedures including compliance and remediation activity.

Ability to interpret and educate on complex concepts, requirements and legislation such as the Knox-Keene Act and HIPAA, State Department of Insurance requirements, Federal and State Health and Human Services requirements/standards as well as CMS, NCQA, and URAC to ensure compliance with complex regulatory structures.

Strategic leader with ability to produce, manage and maintain system-wide change through influence and persuasion.

Advanced knowledge of project management principles, methods, and techniques.

Ability to organize, prioritize, and manage multiple complex projects simultaneously.

Excellent communication skills both written and oral.

High proficiency with core office software (Excel, Word, and PowerPoint).