Associate Behavioral Health Medical Director in United States at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Associate Behavioral Health Medical Director based in the United States.

This role plays a key part in supporting behavioral health clinical excellence across a managed care environment.
It involves providing medical oversight, clinical consultation, and peer-to-peer engagement with providers.
You will conduct utilization reviews, prior authorization determinations, and clinical appeals.
The position also contributes to policy development, quality improvement, and regulatory compliance activities.
You will participate in evaluating complex behavioral health cases, including fraud, abuse, and quality concerns.
This is a highly collaborative role working across clinical, operational, and regulatory teams.
It offers the opportunity to influence care delivery standards while supporting members and providers at scale.

In this role, you will provide clinical leadership and medical expertise in behavioral health utilization management, ensuring appropriate, evidence-based care decisions and compliance with regulatory standards.

• Conduct prior authorization reviews, clinical case evaluations, and behavioral health medical necessity determinations across member populations
• Perform clinical appeals reviews and participate in peer-to-peer discussions with providers to support accurate and fair care decisions
• Provide clinical consultation, training, and education to internal teams and network providers to improve care quality and consistency
• Support fraud, waste, and abuse investigations, as well as quality-of-care reviews and corrective action initiatives
• Contribute to the development and refinement of clinical policies, procedures, and behavioral health guidelines
• Support regulatory, accreditation, and compliance requirements (e.g., CMS, NCQA, URAC, state standards)
• Collaborate with other medical directors for cross-coverage, case escalation, and operational support as needed

This position requires strong clinical expertise in psychiatry, combined with experience in behavioral health care delivery and managed care environments, along with excellent communication and decision-making skills.

• MD or DO degree from an accredited medical school with completion of psychiatry residency
• Board certification in Psychiatry with an active, unrestricted medical license in the United States
• Minimum of 3 years of clinical practice experience in psychiatry, including safe prescribing practices
• Experience in utilization management, medical review, or managed care (preferred)
• Strong understanding of behavioral health clinical guidelines, medical necessity criteria, and care pathways
• Excellent written and verbal communication skills with the ability to engage effectively with providers and stakeholders
• Strong analytical thinking, clinical judgment, attention to detail, and ethical decision-making
• Ability to work independently while collaborating effectively in multidisciplinary teams
• MCG certification required or to be obtained within 6 months of hire

• Competitive salary with potential performance-based bonus incentives
• Comprehensive medical, dental, and vision insurance plans
• Retirement savings plan with employer contribution options
• Paid time off, holidays, and additional leave programs
• Flexible working arrangements depending on operational needs
• Professional development opportunities and continuing education support
• Travel reimbursement where applicable for role-related responsibilities
• Inclusive and mission-driven work environment focused on behavioral health outcomes