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Key Responsibilities:
- Conduct coverage reviews based on individual member plan benefits and policies.
- Document clinical review findings and outcomes in accordance with policies and regulations.
- Engage with requesting providers in peer-to-peer discussions.
Required Qualifications:
- Current unrestricted license to practice in Pennsylvania as an MD or DO.
- Board Certification in Psychiatry.
- Minimum five years of clinical experience post residency.
Knowledge and Skills:
- Knowledge of current behavioral health trends and integration models.
- PC literacy and ability to perform electronic research.
- Strong problem-solving and organizational skills.
Experience and Education:
- Minimum five years clinical experience including inpatient and outpatient mental health.
- At least three years in managed care, utilization review, or quality management.
- MD or DO degree with appropriate board certification.
Capital Blue Cross
Capital Blue Cross is a health insurance company that provides coverage and services. They are consistently voted as one of the Best Places to Work in Pennsylvania, reflecting a positive culture.