Behavioral Health Medical Director (Part-Time)

Overview

Who We Are

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Responsibilities

 What You'll Actually Do:

The Behavioral Health (BH) Medical Director- Part-Time leverages clinical expertise to provide leadership and oversight for behavioral health programs, ensuring high-quality, integrated care for members with behavioral health and substance use needs. Key responsibilities include:

• Oversee and participate in behavioral health case management, including utilization review, telephonic care, and urgent response coordination for behavioral health and substance use disorder needs.
• Conduct reviews for medical necessity for prior authorization, continued stay, and post-service claims, applying medical policy, guidelines, and current research.
• Integrate behavioral health screening and interventions within physical health case management programs, utilizing standardized tools (e.g., PHQ2, PHQ9) and ensuring appropriate referrals.
• Support and monitor virtual behavioral health services, ensuring access, privacy, and continuity of care for all age groups, including children, teens, and adults.
• Supervise and provide clinical oversight for residential and outpatient behavioral health programs, including partial hospitalization and intensive outpatient services, with an emphasis on family engagement and comprehensive discharge planning.
• Lead the development and implementation of comprehensive behavioral health strategies, including program design, staff education, and quality improvement initiatives.
• Maintain compliance with national guidelines (e.g., MCG, InterQual, specialty college recommendations) and regulatory requirements (federal, state, ERISA) specific to behavioral health.
• Oversee the negotiation and implementation of cost management strategies to affect quality outcomes, reflecting data in monthly case management reviews.
• Participate in grievance and appeals processes, including escalated behavioral health issues.
• Collaborate with the VP of Care Management to establish work procedures and processes that support company and departmental standards, procedures, and strategic directives.
• Keep teams informed of clinical and behavioral health updates through educational opportunities and development of educational materials.
• Exercise independence in meeting departmental expectations and compliance timelines.

KEY COMPETENCIES:

• Expertise in behavioral health case management, utilization review and telehealth delivery.

Ability to design and evaluate behavioral health programs, integrating evidence-based practices and holistic wellbeing approaches

• Strong skills in crisis intervention, family engagement, and interdisciplinary collaboration.
• Strong written, verbal and presentation communication skills
• Microsoft Office and other computer skills
• Flexible and able to prioritize day-to-day position requirements
• Strategic thinking with proven ability to communicate a vision and drive results
• Proficient in analysis and interpretation of clinical data
• Comfortable with multiple accountabilities and matrix management
• Proven record of strong relationships and working with diverse teams
• Demonstrated ability to work independently with excellent judgment
• Ability to work from home or in a virtual environment
• Strong interpersonal skills necessary to effectively communicate with medical personnel and members
• Analytical and problem solving skills necessary to identify and review pertinent information
• The ability to incorporate analytical data into new or existing clinical programs to enhance quality of care
• Ability to present data analysis in written format to upper management in a clear, concise manner
• Ability to maintain a very high level of confidentiality
• Able to successfully handle competing priorities
• Experience in the Utilization Review Process which includes Prior-Authorization/Pre-Certification, Retro Reviews, Concurrent Reviews and Post Service Claims Review
• Experience in the grievance and appeals process and ability to work on escalated issues as they arise
• Ability to provide quality oversight to personnel, process improvement and policies and procedures
• Familiarity with National Guid