Senior Medical Director, Behavioral Health

• Oversees 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, care management, and integrated behavioral health/chemical dependency programs.
• Collaborates with regional and enterprise medical/clinical leadership to standardize policies and procedures.
• 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 (FWA) mitigation efforts.
• Hires, trains, develops and manages team demonstrates accountability for team performance and achievement of department-specific goals.
• Develops and sustains a high-performance team, dedicated to best-in-class solutions responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.

• At least 10 years of relevant experience, including behavioral health clinical practice experience, and at least 3 years as a medical director in a managed care setting supporting utilization management and quality initiatives, or equivalent combination of relevant education and experience.
• At least 5 years of management/leadership experience. 
• Doctor of Medicine (MD) or Doctor of Osteopathy (DO), and medical licensure in at least one state within the assigned region. License must be active and unrestricted in state of practice.
• Board certification in Psychiatry or a related behavioral health specialty. 
• Demonstrated experience in multi-state or regional operations, such as standardizing utilization management policies across health plans or navigating varied state Medicaid/Medicare regulations.
guidelines.
• Strong customer service/member-centric focus.
• 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.
• Excellent verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency, and electronic medical record (EMR) proficiency.

• Eligibility for multi-state licensure.
• Behavioral health-specific managed care leadership.
• Experience with value-based contracting, fraud/waste/abuse (FWA) mitigation, integrated behavioral-physical health services, or tools such as MCG/InterQual guidelines and PEGA systems.
• Certifications in health care management or health care quality.

Pay Range: $214,131.6 - $417,556.62 / 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. Remote positions are U.S.-based only. Candidates must reside and be authorized to work in the United States. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.