Bright Health
Through powerful relationships with care partners, Bright Health aims to help people live healthier and brighter lives
Austin, TX
Remote

Determinations Medical Director, Behavioral Health at Bright Health

| Remote
Sorry, this job was removed at 5:37 a.m. (CST) on Wednesday, March 2, 2022
Find out who’s hiring remotely
See all Remote jobs
Apply Now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.

Back to Career Site


Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.


SCOPE OF ROLE

The Bright Healthcare Behavioral Health Medical Director works with our Care Partners to facilitate coverage for a broad array of mental health and substance abuse disorders services. The Medical Director, Behavioral Health is a critical member of our coverage review and case management team.  In collaboration with our non-MD clinicians, the right person uses their medical background, experience, and judgement to make determinations, whether requested services, requested level of care, and/or requested site of service should be authorized for coverage under the benefit plan.  The Medical Director for Behavioral Health will also support peer to peer conversations for authorizations and appeals.  Additional secondary responsibilities include contributing in all ways possible to increasing the value we provide to our members by managing the total cost of care, enabling Bright to offer equitable access to high quality and affordable care. This includes providing input and responding to the business needs related to network development, medical and payment policies, regulatory issues, overall program operations and other matters as arise from time to time. 

ROLE RESPONSIBILITIES

This Medical Director, Behavioral Health roles responsibilities section is intended to point out major responsibilities within the role. 

  • Review determinations for medical necessity
  • Support peer to peer conversations for authorization, appeals and concurrent review
  • Participate in reviews of utilization by line of business and market
  • Teach, mentor and learn from BEH team
  • Support care management and care coordination for members and improve outcomes
  • Support pharmacy and therapeutics committees and formulary development
  • Report and advise on practitioner assessment and credentialling
  • Support development of Mental Health parity process and other regulatory requirements
  • Collaborate with the network team to improve network performance
  • Contribute to policies as needed
  • Other duties and responsibilities as assigned.

SUPERVISORY RESPONSIBILITIES

  • This position does not have supervisory responsibilities. 

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Medical Doctor or Doctor of Osteopathy required.
  • Board certification in Psychiatry required, with preferred additional experience or certification in addiction treatment.
  • Five (5) years or more of clinical practice experience required.  Administrative or managed care experience is highly desirable.
  • An active, unrestricted Medical Doctor (MD) or Doctor of Osteopathy (DO) license to practice as a health professional in a state or territory of the United States is required. Licensure in Texas, Arizona and Illinois preferred.
  • This position requires strong clinical knowledge to support review for medically appropriate utilization of medical services and case management.

PROFESSIONAL COMPETENCIES

  • Excellent clinical and business judgement
  • Independent and self-reliant
  • Critical and creative thinking
  • Strong interpersonal skills to generate collaboration and enable independent decision making amongst internal and external clinical staff
  • Good communication skills with an ability to resolve conflict
  • A drive to build, improve, and succeed

LICENSURES AND CERTIFICATIONS

  • An active, unrestricted Medical Doctor (MD) or Doctor of Osteopathy (DO) license to practice as a health professional in a state or territory of the United States is required. Licensure in Texas, Florida, North Carolina, or Oklahoma preferred.
  • Board certification in Psychiatry required, with preferred certification in addiction treatment.

WORK ENVIRONMENT

  • Remote with option to work in a nearby Bright Healthcare office, as applicable
 
We’re Making Healthcare Right. Together.
We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
 
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
 
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
 
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
 
          
 
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 

See More
Apply Now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.

Where we are

We are downtown at 515 Congress Avenue, right in the heart of downtown! Tons of restaurants and close to public transportation.

Technology we use

  • Engineering
  • Product
  • Sales & Marketing
    • .NETLanguages
    • C#Languages
    • JavaLanguages
    • JavascriptLanguages
    • PythonLanguages
    • RubyLanguages
    • ScalaLanguages
    • SqlLanguages
    • PowerShellLanguages
    • D3JSLibraries
    • ReactLibraries
    • ReduxLibraries
    • FlutterLibraries
    • ASP.NETFrameworks
    • ExpressFrameworks
    • Node.jsFrameworks
    • Ruby on RailsFrameworks
    • SparkFrameworks
    • SpringFrameworks
    • HiveDatabases
    • Microsoft SQL ServerDatabases
    • MongoDBDatabases
    • MySQLDatabases
    • PostgreSQLDatabases
    • InVisionDesign
    • SketchDesign
    • Lucid ChartDesign
    • Aha!Management
    • ConfluenceManagement
    • JIRAManagement
    • Microsoft ProjectManagement
    • Microsoft DynamicsCRM
Previous
Next

What are Bright Health Perks + Benefits

Bright Health Benefits Overview

We have 2 different health insurance plans, all through BlueCross Blue Shield (HDP & PPO). We cover the majority of the cost for the employee and some cost for family. We have two dental plans and a vision plan as well. We have a Lifestyle Spending Account and options for HSA/FSA. We put 4% of your total earnings into your 401K plan and you are immediately vested. We have all the latest technology (Mac or Surface laptops – your choice) to use including standing desks. Fully stocked fridge with snacks and drinks. Last Wednesday of every month is reserved for WellBeing Wednesday where we don't schedule any meeting that day so our employees can focus on deep work or learning something new.

Culture
Volunteer in local community
Partners with Nonprofits
Friends outside of work
Eat lunch together
Daily sync
Open door policy
Team owned deliverables
Team based strategic planning
Group brainstorming sessions
Pair programming
Open office floor plan
Diversity
Dedicated Diversity/Inclusion Staff
Unconscious bias training
Diversity Employee Resource Groups
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Disability Insurance
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Wellness Programs
Bright Health is proud to offer a wellness stipend of $200/month to all employees!
Onsite Gym
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
We will put 3% of your total earnings into your 401K plan, even if you don't put anything in. It's a safe harbor contribution.
401(K) Matching
Bright Health provides employees with a 401(k) plan managed by Vanguard. We provide a ‘safe harbor’ non-elective contribution equal to 3% of your compensation, regardless of participation in the p
Performance Bonus
Child Care & Parental Leave Benefits
Generous Parental Leave
We provide up to 6 weeks of parental leave for the primary caretaker. We also provide 2 weeks of leave for the secondary caretaker.
Flexible Work Schedule
Bright Health provides employees with a flexible work schedule that includes Core hours, Flexible start and end times.
Remote Work Program
Family Medical Leave
Vacation & Time Off Benefits
Generous PTO
Paid Holidays
Paid Sick Days
Perks & Discounts
Casual Dress
Commuter Benefits
Stocked Kitchen
Happy Hours
Happy hours are hosted on occasion.
Relocation Assistance
Fitness Subsidies
Bright Health employees are eligible for discounts on several gym memberships.
Home Office Stipend for Remote Employees
Professional Development Benefits
Tuition Reimbursement
Diversity Program
Lunch and learns
Cross functional training encouraged
Promote from within
Time allotted for learning
Online course subscriptions available
Customized development tracks

Additional Perks + Benefits

Bright's primary goal is to offer employee benefits and perks that are as flexible as possible to meet each employee's unique needs!

An Insider's view of Bright Health

What’s the vibe like in the office?

The office has a relaxed and laid back vibe but people are very serious about their work - perfect!

Anthony

Data Engineer

What does your typical day look like?

My day is so varied, given how quickly we're growing, which is fulfilling for me. I have a good balance of strategic and tactical work in my day as well as time to focus and time to collaborate.

Jen

VP, Digital

What makes someone successful on your team?

A hard-working team player who thinks first and codes next is likely to learn a lot and quickly become a valuable member of the team. Lots of experience with some of our tooling is always nice, but if someone can't knowledge-share well or responds poorly to code reviews and other requests for collaboration, it'll be a tough fit.

Brian

Software Engineer 3

How do your team's ideas influence the company's direction?

We hire smart individuals who thrive on accomplishment and purpose. Our teams are exposed to the bigger picture through constant communication and dialogues – that encourages them to come up with innovative solutions to problems. We've made significant adjustments on our direction in technology and process that were initiated by the team.

Abdullah

VP, Engineering

More Jobs at Bright Health