Job Description

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. Ensures 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

• 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.

Required Qualifications

• 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.

Preferred Qualifications

• 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.

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.