AssociateBehavioralHealthMedicalDirector

## Accountabilities 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 Requirements 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