Medical Director - BH/MH at Jobgether – United States
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About This Position
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Medical Director - BH/MH in United States.
This is a clinically focused leadership role responsible for shaping behavioral health medical strategy and supporting utilization management decisions across a complex healthcare environment. You will evaluate medical necessity, level of care, and site-of-service determinations while ensuring alignment with clinical guidelines, regulatory requirements, and evidence-based standards. The role combines direct clinical judgment with population-level impact, supporting Medicaid and managed care members across diverse care settings. You will collaborate with internal care teams and external physicians to ensure appropriate, high-quality, and timely behavioral health services. This position requires strong clinical expertise, regulatory awareness, and the ability to navigate complex care scenarios. It is ideal for a psychiatrist who is passionate about improving access, quality, and coordination of behavioral health services at scale.
- Review and evaluate behavioral health service requests, determining medical necessity, level of care, and site-of-service decisions using clinical expertise and established guidelines.
- Conduct detailed clinical reviews of complex cases, including inpatient and outpatient behavioral health scenarios, ensuring compliance with Medicaid and regulatory requirements.
- Communicate determinations clearly to internal care teams and participate in case management activities when needed.
- Engage in peer-to-peer discussions with external physicians to gather additional clinical information and resolve clinical decision-making questions.
- Support collaborative relationships with providers, physician groups, and community stakeholders to align care delivery with organizational and regional priorities.
- Apply Medicaid policies, CMS guidelines, and internal clinical frameworks in daily decision-making and operational processes.
- Participate in workload distribution across assigned clusters, including coverage during weekends, holidays, and staffing needs.
- Contribute to a team-based environment aligned with organizational clinical and operational goals.
- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
- Board certification in Psychiatry (ABMS or ABPN recognized specialty).
- Active, unrestricted medical license in at least one state within the assigned cluster, with willingness to obtain additional licensure if required.
- Minimum of 5 years of post-training clinical experience providing direct patient care.
- Experience in utilization management, case management, or health plan-based clinical review strongly required.
- Strong understanding of behavioral health systems, Medicaid programs, and regulatory compliance frameworks.
- Excellent clinical judgment, communication skills, and ability to manage complex decision-making scenarios.
- Ability to collaborate effectively with multidisciplinary teams and external providers.
- Preferred: experience with NCQA accreditation, Medicaid populations, ASAM/MCG criteria, and tools such as CGX or MHK.
- Preferred: licensure through the Interstate Medical Licensure Compact and/or Virginia medical license.
- Competitive annual salary ranging from $223,800 to $313,100
- Eligibility for performance-based bonus incentive program
- Comprehensive medical, dental, and vision insurance
- 401(k) retirement savings plan
- Paid time off including vacation, holidays, volunteer time, and parental/caregiver leave
- Short-term and long-term disability coverage
- Life insurance and additional well-being support programs
- Remote work flexibility within eligible U.S. states
- Occasional travel opportunities for training and organizational meetings
- Strong focus on whole-person well-being and professional sustainability.