Medical Director, Behavioral Health (TX/WA)

JOB DESCRIPTION Job Summary Molina'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. Knowledge/Skills/Abilities Provides Psychiatric leadership for utilization management and case management programs for mental health and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management policies and procedures to improve quality outcomes and decrease costs. u2022 Provide regional medical necessity reviews and cross coverage u2022 Standardizes UM practices and quality and financial goals across all LOBs u2022 Responds to BH-related RFP sections and review BH portions of state contracts u2022 Assist the BH MD lead trainers in the development of enterprise-wide teaching on psychiatric diagnoses and treatment u2022 Provides second level BH clinical reviews, BH peer reviews and appeals u2022 Supports BH committees for quality compliance. u2022 Implements clinical practice guidelines and medical necessity review criteria u2022 Tracks all clinical programs for BH quality compliance with NCQA and CMS u2022 Assists with the recruitment and orientation of new Psychiatric MDs u2022 Ensures all BH programs and policies are in line with industry standards and best practices u2022 Assists with new program implementation and supports the health plan in-source BH services u2022 Additional duties as assigned Job Qualifications REQUIRED EDUCATION: u2022 Doctorate Degree in Medicine (MD or DO) with Board Certification in Psychiatry REQUIRED EXPERIENCE: u2022 2 years previous experience as a Medical Director in clinical practice u2022 3 yearsu2019 experience in Utilization/Quality Program Management u2022 2+ years HMO/Managed Care experience u2022 Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen. u2022 Knowledge of applicable state, federal and third-party regulations Required License, Certification, Association Active and unrestricted State (TX) Medical License, free of sanctions from Medicaid or Medicare. Preferred Experience u2022 Peer Review, medical policy/procedure development, provider contracting experience. u2022 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. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina 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.

Created: 2025-09-15