JOB DESCRIPTION
Job Summary
Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs.
Knowledge/Skills/Abilities
Provides Psychiatric leadership for utilization management and case management programs for mental health and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management policies and procedures to improve quality outcomes and decrease costs.
• Provide regional medical necessity reviews and cross coverage
• Standardizes UM practices and quality and financial goals across all LOBs
• Responds to BH-related RFP sections and review BH portions of state contracts
• Assist the BH MD lead trainers in the development of enterprise-wide teaching on psychiatric diagnoses and treatment
• Provides second level BH clinical reviews, BH peer reviews and appeals
• Supports BH committees for quality compliance.
• Implements clinical practice guidelines and medical necessity review criteria
• Tracks all clinical programs for BH quality compliance with NCQA and CMS
• Assists with the recruitment and orientation of new Psychiatric MDs
• Ensures all BH programs and policies are in line with industry standards and best practices
• Assists with new program implementation and supports the health plan in-source BH services
• Additional duties as assigned
Job Qualifications
REQUIRED EDUCATION:
• Doctorate Degree in Medicine (MD or DO) with Board Certification in Psychiatry
REQUIRED EXPERIENCE:
• 2 years previous experience as a Medical Director in clinical practice
• 3 years' experience in Utilization/Quality Program Management
• 2+ years HMO/Managed Care experience
• Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.
• Knowledge of applicable state, federal and third-party regulations
Required License, Certification, Association
Active and unrestricted State Medical License, free of sanctions from Medicaid or Medicare.
Preferred Experience
• Peer Review, medical policy/procedure development, provider contracting experience.
• Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJHS
#LI-AC1
Pay Range: $161,914.25 - $315,733 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Receive real-time job alerts and never miss the right job again
Franklin Dental and Braces a Benevis company
US - GA - GA - Eton
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Ellijay
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Panthersville
April 24, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Calhoun
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Lyerly
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Youth Dentistry and Braces a Benevis company
US - GA - GA - Montgomery
April 21, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Belvedere Park
April 24, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Rossville
May 7, 2025
Overview: • Pay range $45-58 per hour but negotiable depending on experience.Up to 10k Sign-on or relocation bonus for full-time and 5k for part-time, plus Production pay opportunityBenefits, 401K, PTO, Continuing Education credits, flexible schedulesAttractive Sign-on Bonus and Comprehensive...
Franklin Dental and Braces a Benevis company
US - GA - GA - Plainville
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Fort Oglethorpe
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Chickamauga
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Redan
April 24, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Fairmount
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Rossville
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Adairsville
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Shannon
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - North Druid Hills
April 24, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - North Decatur
April 24, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Youth Dentistry and Braces a Benevis company
US - GA - GA - Wilmington Island
April 21, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Summerville
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Candler-McAfee
April 24, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - East Ellijay
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Lookout Mountain
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Dalton
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Indian Springs
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Cohutta
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...
Franklin Dental and Braces a Benevis company
US - GA - GA - Ringgold
April 27, 2025
Overview: • Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do!...