Medical Director, Behavioral Health (WA)

JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties u2022 Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs. u2022 Facilitates behavioral health-related regional medical necessity reviews and cross coverage. u2022 Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses. u2022 Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts. u2022 Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment. u2022 Provides second level behavioral health clinical reviews, peer reviews and appeals. u2022 Supports behavioral health committees for quality compliance. u2022 Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. u2022 Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). u2022 Assists with the recruitment and orientation of new psychiatric medical directors. u2022 Ensures all behavioral health programs and policies are in line with industry standards and best practices. u2022 Assists with new program implementation and supports for health plan in-source behavioral health services. Required Qualifications u2022 At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience. u2022 Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice. u2022 Board Certification in Psychiatry. u2022 Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. u2022 Ability to work cross-collaboratively within a highly matrixed organization. u2022 Strong organizational and time-management skills. u2022 Ability to multi-task and meet deadlines. u2022 Attention to detail. u2022 Critical-thinking and active listening skills. u2022 Decision-making and problem-solving skills. u2022 Strong verbal and written communication skills. u2022 Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications u2022 Experience with utilization/quality program management. u2022 Managed care experience. u2022 Peer review experience. u2022 Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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: 2025-10-06