Behavioral Health Medical Director – Psychiatrist – California Medicaid (Part-Time)

Elevance Health•Mesa, CA

22d•Remote

About The Position

The Behavioral Health Medical Director is responsible for overseeing California Medicaid behavioral health services, with a primary focus on conducting utilization management (UM) reviews across all levels of care. Key responsibilities include monitoring and analyzing behavioral health trends within the health plan, serving as a clinical advisor and thought leader through ongoing collaboration with health plan partners, and providing support to behavioral health UM and case management teams beyond individual case reviews. The position also offers cross-coverage support for other medical directors as needed, while maintaining a primary focus on California Medicaid behavioral health populations. This role enables associates to work virtually full-time, with the exception of required in-person meetings, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face collaboration. Candidates must live in California. The salary range for this specific position is $178,135 to $290,437.50.

Requirements

Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
Must possess an active unrestricted medical license to practice medicine or a health profession in the state of California.
Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
Candidates must live in California.

Nice To Haves

Child and Adolescent, Addiction Psychiatry/Medicine board certification preferred.

Responsibilities

Supports clinicians to ensure timely and consistent responses to members and providers.
Provides guidance for clinical operational aspects of a program.
Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients’ office visits with providers and external physicians.
May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
Serves as a resource and consultant for other areas of the company.
May be required to represent the company to external entities and/or serve on internal and/or external committees.
May chair company committees.
Interprets medical policies and clinical guidelines.
May develop and propose new medical policies based on changes in healthcare.
Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
Identifies and develops opportunities for innovation to increase effectiveness and quality.
Overseeing California Medicaid behavioral health services, with a primary focus on conducting utilization management (UM) reviews across all levels of care.
Monitoring and analyzing behavioral health trends within the health plan.
Serving as a clinical advisor and thought leader through ongoing collaboration with health plan partners.
Providing support to behavioral health UM and case management teams beyond individual case reviews.
Offering cross-coverage support for other medical directors as needed, while maintaining a primary focus on California Medicaid behavioral health populations.