Behavioral Health Medical Director

Job Summary:

The Behavioral Health Medical Director provides clinical oversight for behavioral health services across ElderServe Health. Serves as the clinical authority for behavioral health programs, medical management activities, utilization review, quality improvement initiatives, and clinical policy development. Partners with interdisciplinary teams to ensure the delivery of high-quality, evidence-based behavioral health care while supporting regulatory compliance, operational effectiveness, and improved health outcomes. Provides expert clinical consultation and medical judgment to support organizational decision-making and the ongoing advancement of behavioral health services.

Essential Functions:

• Provides clinical leadership and oversight for behavioral health services to ensure delivery of evidence-based, high-quality care consistent with organizational standards and regulatory requirements.
• Serves as the behavioral health clinical subject matter expert and provides medical consultation on psychiatric care, substance use disorder treatment, and behavioral health best practices.
• Reviews complex behavioral health cases and provides medical judgment regarding treatment appropriateness, medical necessity, care planning, and clinical outcomes.
• Participates in BH utilization management activities including prior authorization reviews, peer-to-peer consultations, appeals, grievances, and other clinical review processes.
• Leads the development, implementation, interpretation, and ongoing evaluation of behavioral health clinical policies, practice guidelines, and medical management criteria.
• Partners with clinical and operational leaders to identify opportunities to improve behavioral health quality, access, member experience, and health outcomes.
• Evaluates behavioral health utilization, quality, and clinical performance data to identify trends, risks, and opportunities for improvement.
• Collaborates with interdisciplinary teams to promote coordination between behavioral health, physical health, pharmacy, and care management services to support whole-person care.
• Participates in credentialing, recredentialing, peer review, and provider quality oversight activities to support clinical excellence and regulatory compliance.
• Serves on and provides clinical leadership to committees, workgroups, and governance forums focused on quality, utilization management, patient safety, and behavioral health program effectiveness.
• Provides clinical consultation and recommendations to organizational leadership regarding behavioral health strategy, regulatory requirements, and program development initiatives.
• Ensures compliance with applicable federal and state regulations, accreditation standards, contractual obligations, and organizational policies pertaining to behavioral health services.
• Represents ESH in interactions with providers, regulatory agencies, community organizations, and external stakeholders on behavioral health clinical matters.
• Perform any other job related duties as requested.

Education and Experience:

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) required
• Five (5) years of clinical practice experience in behavioral health, psychiatry, managed care, or a related healthcare setting required
• Three (3) years of leadership experience involving clinical program oversight, medical management, or quality improvement activities required
• Experience in Medicaid, Medicare, managed care, or health plan environments preferred
• Experience with utilization management, quality management, and population health initiatives preferred

Competencies, Knowledge and Skills:

• Ability to align clinical strategies with organizational goals, regulatory requirements, and industry standards
• Skill in evaluating complex clinical issues and applying sound medical judgment
• Knowledge of psychiatry, substance use disorders, integrated care models, and evidence-based behavioral health practices
• Ability to analyze clinical and operational data to improve quality, outcomes, and performance
• Skill in developing effective partnerships and influencing stakeholders across all organizational levels
• Ability to communicate complex clinical information clearly to diverse audiences
• Skill in facilitating collaboration, consensus-building, and informed decision-making
• Ability to identify and implement innovative solutions and process improvements
• Knowledge of healthcare regulations, accreditation standards, and contractual requirements
• Ability to remain current on emerging behavioral health trends, practices, and regulatory changes

Licensure and Certification:

• Current unrestricted license to practice