Medical Director, Behavioral Health (TX/WA)

OverviewMolina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs.ResponsibilitiesProvide regional medical necessity reviews and cross coverageStandardizes UM practices and quality and financial goals across all LOBsResponds to BH-related RFP sections and review BH portions of state contractsAssist the BH MD lead trainers in the development of enterprise-wide teaching on psychiatric diagnoses and treatmentProvides second level BH clinical reviews, BH peer reviews and appealsSupports BH committees for quality compliance.Implements clinical practice guidelines and medical necessity review criteriaTracks all clinical programs for BH quality compliance with NCQA and CMSAssists with the recruitment and orientation of new Psychiatric MDsEnsures all BH programs and policies are in line with industry standards and best practicesAssists with new program implementation and supports the health plan in-source BH servicesAdditional duties as assignedQualificationsREQUIRED EDUCATION: Doctorate Degree in Medicine (MD or DO) with Board Certification in PsychiatryREQUIRED EXPERIENCE: 2 years previous experience as a Medical Director in clinical practice; 3 years’ experience in Utilization/Quality Program Management; 2+ years HMO/Managed Care experience; Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen; Knowledge of applicable state, federal and third-party regulationsRequired License, Certification, Association Active and unrestricted State (TX) Medical License, free of sanctions from Medicaid or Medicare.Preferred ExperiencePeer Review, medical policy/procedure development, provider contracting experience.Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.Application and BenefitsMolina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.Pay Range: $161,914.25 - $315,733 / ANNUAL*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. #J-18808-Ljbffr

Created: 2025-10-06