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Behavioral Health Medical Director

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Personify Health

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Location:
United States

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Category:
Health and Beauty

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Contract Type:
Not provided

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Salary:

189600.00 - 237000.00 USD / Year
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Job Description:

The Behavioral Health (BH) Medical Director leverages clinical expertise to provide leadership and oversight for behavioral health programs, ensuring high-quality, integrated care for members with behavioral health and substance use needs.

Job Responsibility:

  • Oversee and participate in behavioral health case management, including utilization review, telephonic care, and urgent response coordination for behavioral health and substance use disorder needs
  • Conduct reviews for medical necessity for prior authorization, continued stay, and post-service claims, applying medical policy, guidelines, and current research
  • Integrate behavioral health screening and interventions within physical health case management programs, utilizing standardized tools (e.g., PHQ2, PHQ9) and ensuring appropriate referrals
  • Support and monitor virtual behavioral health services, ensuring access, privacy, and continuity of care for all age groups, including children, teens, and adults
  • Supervise and provide clinical oversight for residential and outpatient behavioral health programs, including partial hospitalization and intensive outpatient services, with an emphasis on family engagement and comprehensive discharge planning
  • Lead the development and implementation of comprehensive behavioral health strategies, including program design, staff education, and quality improvement initiatives
  • Maintain compliance with national guidelines (e.g., MCG, InterQual, specialty college recommendations) and regulatory requirements (federal, state, ERISA) specific to behavioral health
  • Oversee the negotiation and implementation of cost management strategies to affect quality outcomes, reflecting data in monthly case management reviews
  • Participate in grievance and appeals processes, including escalated behavioral health issues
  • Collaborate with the VP of Care Management to establish work procedures and processes that support company and departmental standards, procedures, and strategic directives
  • Keep teams informed of clinical and behavioral health updates through educational opportunities and development of educational materials
  • Exercise independence in meeting departmental expectations and compliance timelines

Requirements:

  • MD or DO degree and 5+ years of direct clinical patient care experience post residency or fellowship including behavioral health environments
  • Current and ongoing Board Certification in psychiatry by the American Board of Psychiatry and Neurology (ABPN) required
  • Additional Board Certification in Child and Adolescent Psychiatry or Addiction Medicine
  • A current and unrestricted license in the state of California and willing to obtain additional license(s)
  • No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
  • Minimum 5 years of Utilization Review or Hospital experience required
  • Minimum 3 years of compliance related experience preferred
  • Managed Care experience preferred in utilization review and case management
  • Expertise in behavioral health case management, utilization review and telehealth delivery
  • Ability to design and evaluate behavioral health programs, integrating evidence-based practices and holistic wellbeing approaches
  • Strong skills in crisis intervention, family engagement, and interdisciplinary collaboration
  • Strong written, verbal and presentation communication skills
  • Microsoft Office and other computer skills
  • Flexible and able to prioritize day-to-day position requirements
  • Strategic thinking with proven ability to communicate a vision and drive results
  • Proficient in analysis and interpretation of clinical data
  • Comfortable with multiple accountabilities and matrix management
  • Proven record of strong relationships and working with diverse teams
  • Demonstrated ability to work independently with excellent judgment
  • Ability to work from home or in a virtual environment
  • Strong interpersonal skills necessary to effectively communicate with medical personnel and members
  • Analytical and problem solving skills necessary to identify and review pertinent information
  • The ability to incorporate analytical data into new or existing clinical programs to enhance quality of care
  • Ability to present data analysis in written format to upper management in a clear, concise manner
  • Ability to maintain a very high level of confidentiality
  • Able to successfully handle competing priorities
  • Experience in the Utilization Review Process which includes Prior-Authorization/Pre-Certification, Retro Reviews, Concurrent Reviews and Post Service Claims Review
  • Experience in the grievance and appeals process and ability to work on escalated issues as they arise
  • Ability to provide quality oversight to personnel, process improvement and policies and procedures
  • Familiarity with National Guidelines such as MCG or InterQual, medical policy or commonly used guidelines from Specialty Colleges
  • Experience in disease management with knowledge and understanding of disease progression
  • Knowledgeable of the Federal, State and ERISA regulations

Nice to have:

  • Managed Care experience preferred in utilization review and case management
  • Minimum 3 years of compliance related experience preferred
What we offer:
  • Comprehensive medical and dental coverage through our own health solutions
  • Mental health support and wellness programs designed by experts who get it
  • Flexible work arrangements that fit your life
  • Retirement planning support to help you build real wealth for the future
  • Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
  • Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage
  • Professional development opportunities and clear career progression paths
  • Mentorship from industry leaders who want to see you succeed
  • Learning budget to invest in skills that matter to your future
  • Unlimited PTO policy
  • Benefits effective day one

Additional Information:

Job Posted:
January 02, 2026

Employment Type:
Parttime
Work Type:
Remote work
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