Behavioral Health Utilization Management Medical Director; Psychiatry

Overview

WHO IS GUIDEHEALTH?
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Health guides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.

Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.

Join us as we put healthcare on a better path!

Guidehealth is seeking a Behavioral Health Utilization Management Medical Director (Psychiatry) to serve as a part-time, 1099 consultant supporting utilization management activities for a commercial health plan. This role provides physician-level clinical review and consultative leadership across behavioral health services, ensuring medical necessity determinations are clinically sound, timely, and compliant with regulatory and accreditation standards. This opportunity is well suited for a psychiatrist with managed care or utilization management experience who is seeking flexible, non-clinical consulting work.

• Utilization Management & Medical Necessity Review:
  Performing physician-level utilization management reviews for behavioral health services across all applicable levels of care, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient services. Rendering medical necessity determinations using Company-approved, evidence-based criteria (e.g., Inter Qual®, MCG®, or plan-specific guidelines). Reviewing escalated, complex, and reconsideration cases, including first- and second-level appeals, as requested. Ensuring determinations are timely, clinically appropriate, and consistently applied across commercial product lines.
• Peer-to-Peer & Provider Engagement:
  Conducting peer-to-peer consultations with treating psychiatrists and other behavioral health providers. Communicating clear, clinically sound rationales for utilization management decisions. Supporting resolution of provider disputes related to medical necessity or level-of-care determinations.
• Mental Health Parity & Regulatory Compliance (MHPAEA):
  Applying utilization management criteria and processes in compliance with MHPAEA. Ensuring non-quantitative treatment limitations (NQTLs), including prior authorization requirements, review standards, and clinical criteria application, are comparable to and no more stringent than those applied to medical/surgical benefits. Supporting parity analyses, documentation, and regulatory inquiries as requested. Providing clinical input on parity-related policies, utilization management practices, and corrective action plans.
• Accreditation & Quality Support:
  Performing utilization management activities in alignment with NCQA Health Plan Accreditation standards. Supporting readiness for NCQA surveys, audits, and corrective actions related to behavioral health utilization management. Assisting with the development, review, or refinement of utilization management policies and procedures to maintain accreditation compliance.
• Clinical Advisory & Program Support:
  Serving as a consultative clinical resource to behavioral health utilization management nurses, care managers, and operational leaders. Providing recommendations to improve utilization management consistency, quality, efficiency, and provider experience. Participating in scheduled or ad hoc clinical, quality, or utilization review meetings as requested.
• Deliverables:
  Deliverables may include, but are not limited to, timely completion and documentation of assigned utilization management reviews and determinations; written clinical rationales supporting authorization, denial, or modification decisions; documentation supporting MHPAEA compliance and NCQA standards, as applicable; verbal or written recommendations related to utilization management process or policy improvements.

Required Qualifications

• MD or DO with board certification or board eligibility in Psychiatry
• Active, unrestricted Illinois medical license (required)
• Minimum of 3 years of post-residency psychiatric practice
• Prior experience in utilization management, managed care, or medical director roles

What We’d Love for You to Have

• Experience supporting commercial health plans
• Familiarity with behavioral health parity and accreditation standards (e.g., NCQA)
• Strong peer-to-peer communication and clinical documentation skills

• 1099 independent contractor engagement
• Part-time, flexible schedule (approximately 6 hours per week)
• No minimum hours guaranteed
• Must maintain sufficient availability to meet regulatory and turnaround time requirements

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