Medical Director II, Behavioral Health

JOB DESCRIPTION Job Summary

Provides lead level 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.
• Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management.
• Implements clinical practice standards and corporate policies and participates in management of activities.
• Develops, implements, and interprets medical policy, technology assessments and medical necessity guidelines.
• Provides regional medical necessity reviews and cross-coverage.
• Standardizes utilization management practices and quality and financial goals across all lines of business.
• Responds to behavioral health-related request for proposal (RFP) sections and review behavioral health portions of state contracts.
• Develops and provides enterprise-wide education on psychiatric diagnoses and treatment.
• Assists regional medical leads with auditing.
• Provides second level behavioral health clinical reviews, behavioral health peer reviews and appeals.
• Supports behavioral health committees for quality compliance.
• Implements 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) guidelines.
• Recruits and onboards new behavioral health medical directors.
• Ensures all behavioral health programs and policies are in line with industry standards and best practices
• Develops new behavioral health programs, leads implementation efforts, and supports health plan(s) with in-source behavioral health services.
• Assist with reviewing and evaluating behavioral health vendors.

Required Qualifications

• At least 5 years of relevant experience, including at least 2 years of medical practice experience in psychiatry/behavioral health, and at least 2 years as a medical director in a managed care organization setting supporting utilization management/quality program management, 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 of practice.
• Board certification in psychiatry.
• Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff.
• Demonstrated peer review proficiency.
• 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

• Leadership 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.

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: $186,201.39 - $363,093 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type Full Time Posting Date 10/16/2025