Director of Behavioral Health Services

Overview

JOB DESCRIPTION

Molina's Behavioral Health function leads innovative programs for mental health and substance use treatment. We provide direction and expertise in utilization management and case management, helping to implement integrated care management strategies that enhance patient outcomes.

Responsibilities

• Conduct regional medical necessity reviews and provide cross coverage support.
• Standardize utilization management practices and align quality and financial objectives across all lines of business.
• Review behavioral health-related RFP sections and analyze behavioral health components within state contracts.
• Collaborate with BH MD lead trainers to develop comprehensive training on psychiatric diagnoses and treatment standards.
• Perform second-level behavioral health clinical reviews, peer reviews, and manage appeal processes.
• Support behavioral health committees focused on quality compliance.
• Implement best practices in clinical guidelines and medical necessity review criteria.
• Monitor all clinical programs to ensure compliance with NCQA and CMS standards.
• Assist in the recruitment and onboarding of new Psychiatric MDs.
• Ensure alignment of all behavioral health programs and policies with industry standards and best practices.
• Participate in the implementation of new programs and support the transition to in-source BH services.
• Carry out additional responsibilities as assigned.

Job Qualifications

REQUIRED EDUCATION :

REQUIRED EXPERIENCE :

Required License, Certification, Association

PREFERRED EXPERIENCE :

Join us at Molina Healthcare, where we offer a competitive benefits and compensation package. We are committed to creating an inclusive environment and welcome applications from all qualified candidates. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

Pay Range : $161,914.25 - $315,733 / ANNUAL