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Job Description

Job Summary

Leads a regional team of medical directors and clinical staff, providing psychiatric oversight and expertise in the medical necessity, appropriateness, and quality of behavioral health services (mental health and substance use disorders) across multiple states. Ensure members receive clinically appropriate, evidence-based care in the most effective setting while contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, and cost-effective quality outcomes in a managed care environment. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

+ Leads and manages a team of medical directors and behavioral health clinicians responsible for prior authorization, inpatient concurrent review, discharge planning, care management, and interdisciplinary care team activities across a designated multi-state region.

+ Provides psychiatric leadership and clinical expertise for utilization management, case management, and integrated behavioral health/chemical dependency programs; collaborates with regional and enterprise leadership to standardize policies and procedures.

+ Recruits, hires, trains, mentors, and develops medical director staff and team members as needed.

+ Ensures authorization decisions are rendered by qualified personnel without influence from fiscal or administrative incentives, in compliance with regulatory and accreditation standards.

+ Analyzes regional data to identify behavioral health cost-savings opportunities, quality improvements, and utilization trends (e.g., prior authorizations, outlier management).

+ Facilitates regional medical necessity reviews, cross-coverage, and responses to state-specific regulatory inquiries, complaints, or requests for proposals (RFPs).

+ Contributes to the development and implementation of behavioral health medical policies, peer review processes, provider education, and contract reviews.

+ Represents the organization in regional stakeholder engagements, including state regulators, providers, and advocacy groups.

+ Conducts peer reviews and supports fraud, waste, and abuse mitigation efforts.

Job Qualifications

Required Qualifications

+ Doctor of Medicine (MD) or Doctor of Osteopathy (DO), with board certification in Psychiatry or a related behavioral health specialty.

+ Medical license in at least one state within the assigned region. License must be active and unrestricted in state of practice.

+ At least 8 years of relevant experience, including clinical practice in behavioral health and at least 3 years as a medical director in a managed care setting supporting utilization management and quality initiatives.

+ At least 3 years management/leadership experience.

+ Demonstrated experience in multi-state or regional operations, such as standardizing utilization management policies across health plans or navigating varied state Medicaid/Medicare regulations.

+ Working knowledge of national, state, and local laws; regulatory requirements (e.g., NCQA, HEDIS); and evidence-based clinical criteria for behavioral health.

+ Proven ability to lead in a highly matrixed organization, build consensus, and make strategic decisions.

+ Strong verbal and written communication skills, with proficiency in Microsoft Office suite and applicable clinical software systems.

Preferred Qualifications

+ Eligibility for multi-state licensure. 5+ years in behavioral health-specific managed care leadership.

+ Experience with value-based contracting, fraud/waste/abuse mitigation, integrated behavioral-physical health services, or tools such as MCG/InterQual guidelines and PEGA systems.

+ Certifications in healthcare management (e.g., CPE) or advanced degrees (e.g., MBA).

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: $214,132 - $417,557 / ANNUAL

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