Primary responsibility involves serving as the Medical Director overseeing the occupational health and disability leave management program, with a focus on psychiatric cases. Responsibilities include: Providing clinical case management advisement, treating provider contacts, and employee contacts. Developing strategic plans and providing oversight of behavioral health claim management services. Assisting case managers in understanding the emotional, behavioral, and cognitive functioning of employees/claimants in relation to work demands. Offering initial and ongoing clinical guidance, reviewing treatment plans, and assessing standards of care for projected return-to-work dates. Conducting comprehensive disability claim file reviews and peer-to-peer consults to address specific questions and claim dynamics. Supporting operational functions through consultation with clients, vendors, internal leadership, and case managers. Directing and coordinating psychiatric reviews and complex claim discussions related to disability, accommodations, and permanent restrictions. Providing physician coverage for the team when the lead physician is unavailable.
Additionally, providing clinical oversight and training to a team of nurse and behavioral health case managers, including:
Consulting and interpreting information related to psychiatric disability and leave of absence claims. Training case manager personnel on various behavioral health topics. Providing ongoing support through consultation and daily "walk-in" hours for case management discussion. Conducting file reviews, peer-to-peer consults, and negotiations with treating providers. Negotiating with employees and clients/employers to streamline return-to-work processes. Utilizing client wellness resources and critical thinking skills to ensure optimal outcomes. Collaborating with client Human Capital Management and Employment Law teams in managing medical leaves of absence and accommodations. Requirements: Active state or jurisdiction healthcare provider licensure. Board Certification from the American Board of Psychiatry and Neurology (ABPN). Minimum 5 years of experience in reviewing disability claims related to psychiatric conditions. Maintains Applicable Certifications (e.g., The American Board of Independent Examiners, The American Academy of Disability Evaluating Physicians). Demonstrates empathy, compassion, and professionalism in interactions with customers and in coaching case managers. Champions change management and leads initiatives to ensure best practices are implemented. Possesses a strong working knowledge of medical and behavioral health disorders. Can integrate quickly into a fast-paced working environment and develop valuable interpersonal business relationships with stakeholders. Able to convey clinical opinions clearly and efficiently to non-clinical stakeholders. Receptive to feedback.
