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 Healthguides™ 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.

What You’ll Be Doing

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., InterQual®, 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 the Mental Health Parity and Addiction Equity Act (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

What You’ll Need for success

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

Engagement Details

• 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

ALIVE with Purpose: How We Thrive at Guidehealth 

At Guidehealth, our values come to life in everything we do. 

• We are Driven by Accountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike. 
• Always Growing, Always Learning — staying curious and continuously improving inspires us to shape a better future for healthcare. 
• With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve. 
• At Guidehealth, Every Voice Matters — we believe our collective strength is rooted in the unique perspectives of each team member. 
• And through Empathy in Action, we build stronger connections with those who count on us. 
• This is what it means to be ALIVE with purpose. This is how we thrive — together — at Guidehealth. 

BENEFITS:

While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.  

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles, the responsibilities would be further defined by the hiring manager. 

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download, 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements.