Healthcare - Medical Director (39)

Behavioral Health Physician (MD/DO) – Utilization Management (1099 Contractor)

Direct placement opportunity - the physician will be directly contracted with Molina as a 1099. Supplier will receive direct hire placement in the amount of $2,500.00. Estimated hours per week: Range of 15– 40 hours/week. Hourly pay rate: Range will depend on the specialty, licenses, clinical and MCO experience: $50 - $57/case for all UM, $150-$170/hour for mandatory trainings and meetings.

Required licensure: TX, KY, FL, WA licenses are preferred.

Role Summary

The Behavioral Health Physician will serve as an independent contractor providing physician-level utilization management (UM) services for behavioral health services. This role is non-clinical and limited exclusively to medical necessity determinations, peer-to-peer reviews, and appeals in accordance with applicable regulations, accreditation standards, and plan policies.

Scope of Services

The Contractor will perform UM activities including, but not limited to:

• Initial Medical Necessity Reviews for behavioral health services requiring physician-level determination
• Concurrent Reviews for continued authorization of services
• Peer-to-Peer (P2P) Reviews with treating providers
• Appeals Reviews, including first- and second-level determinations, as applicable
• Issuance of adverse determinations when clinically indicated, ensuring compliance with federal and state regulations, parity requirements, and plan policies
• Documentation of determinations in UM systems with clear clinical rationale and supporting criteria
• Participation in quality improvement processes related to UM decisions, as requested

Exclusions / Non-Scope

This role does not include:

• Direct patient care or treatment
• Prescribing services
• Care coordination or case management
• Administrative leadership or supervisory responsibilities

Clinical Expertise & Requirements

MD or DO with board certification in Psychiatry (required). Active, unrestricted medical license in applicable state(s) of review. Experience in behavioral health utilization management, preferably in managed care or health plan settings. Demonstrated knowledge of:

• Medical necessity criteria (e.g., MCG, InterQual, or equivalent)
• Federal and state behavioral health regulations
• MHPAEA requirements
• NCQA and CMS standards

Strong peer-to-peer communication skills.

Work Expectations

Independent contractor (1099) status. Remote work environment. Flexible scheduling based on case volume and turnaround time requirements. Ability to meet required regulatory and contractual decision timelines. Maintain confidentiality and comply with HIPAA and data security standards.

Reporting & Oversight

Operates independently while adhering to health plan UM policies, delegated authority parameters, and medical policy. Subject to audit, quality oversight, and performance monitoring consistent with UM regulatory requirements.