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 complianceImplements 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 assignedJob QualificationsRequired EducationDoctorate Degree in Medicine (MD or DO) with Board Certification in PsychiatryRequired Experience2 years previous experience as a Medical Director in clinical practice3 years’ experience in Utilization/Quality Program Management2+ years HMO/Managed Care experienceExperience 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, AssociationActive 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.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. #J-18808-Ljbffr

Created: 2025-10-06