Medical Director, Behavioral Health (Based in AZ)

Molina Healthcare; Phoenix (AZ); On-site; USD 186,000 - 363,000; Full time

Job summary

Molina Healthcare is seeking a physician leader to provide medical oversight and clinical leadership for behavioral health and chemical dependency services across markets, assisting with integrated care program implementation and strategy.

The role emphasizes standardizing utilization management, guiding reviews, education, and ensuring NCQA/CMS compliance, while supporting recruitment of psychiatric medical directors and aligning policies with best practices.

Qualifications

• At least 3 years of relevant experience, including 2 years in psychiatry/behavioral health, or equivalent education/experience.
• MD or DO with unrestricted license in AZ.
• Board certification in Psychiatry.
• Knowledge of national/state/local laws affecting medical staff.
• Ability to work cross-collaboratively in a matrixed organization.

Responsibilities

• Provide behavioral health oversight and clinical leadership for utilization management and care management programs.
• Facilitate regional medical necessity reviews and cross-coverage.
• Standardize behavioral health goals across lines of business.
• Support QA and compliance with NCQA and CMS requirements.
• Assist with recruitment and orientation of psychiatric medical directors.
• Ensure programs align with industry standards and best practices.

Skills

Medical leadership

Cross-functional collaboration

Organizational skills

Time management

Communication skills

Decision-making

Problem solving

Attention to detail

Active listening

Multi-tasking

Education

MD/DO degree

Board certification in Psychiatry

Tools

Microsoft Office

Job description

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

• 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.
• Facilitates behavioral health-related regional medical necessity reviews and cross coverage.
• Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses.
• Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts.
• Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment.
• Provides second level behavioral health clinical reviews, peer reviews and appeals.
• Supports behavioral health committees for quality compliance.
• Implements behavioral health specific clinical practice guidelines and medical necessity review criteria.
• Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS).
• Assists with the recruitment and orientation of new psychiatric medical directors.
• Ensures all behavioral health programs and policies are in line with industry standards and best practices.
• Assists with new program implementation and supports for health plan in-source behavioral health services.

Required Qualifications

• 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.
• Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state (AZ) of practice.
• Board Certification in Psychiatry.
• Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff.
• Ability to work cross-collaboratively within a highly matrixed organization.
• Strong organizational and time-management skills.
• Ability to multi-task and meet deadlines.
• Attention to detail.
• Critical-thinking and active listening skills.
• Decision-making and problem-solving skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs.

Preferred Qualifications

• Experience with utilization/quality program management.
• Managed care experience.
• Peer review experience.
• 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.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $186,201.39 - $363,093 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.