Personify Health

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 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 Guidelines such as MCG or InterQual, medical policy or commonly used guidelines from Specialty Colleges
• Experience in disease management with knowledge and understanding of disease progression.
• Knowledgeable of the Federal, State and ERISA regulations

Qualifications

What You Bring to Our Mission

QUALIFICATIONS:

• MD or DO degree and 5+ years of direct clinical patient care experience post residency or fellowship including behavioral health environments.
• Current and ongoing Board Certification in psychiatry by the American Board of Psychiatry and Neurology (ABPN) required.
• Additional Board Certification in Child and Adolescent Psychiatry or Addiction Medicine.
• A current and unrestricted license in the state of California and willing to obtain additional license(s).
• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
• Minimum 5 years of Utilization Review or Hospital experience required.
• Minimum 3 years of compliance related experience preferred.
• Managed Care experience preferred in utilization review and case management.

Physical and Mental Requirements:

• Ability to safely and successfully perform the essential job functions with or without a reasonable accommodation, including meeting qualitative and/or quantitative productivity standards.
• Constant use of computer keyboard and mouse; repetitive use of both hands.
• Occasional to frequent twisting of neck; occasional bending of neck and at waist.

Why You'll Love It Here

We believe in total rewards that actually matter—not just competitive packages, but benefits that support how you want to live and work.

Your wellbeing comes first:

• Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!)
• Mental health support and wellness programs designed by experts who get it
• Flexible work arrangements that fit your life, not the other way around

Financial security that makes sense:

• Retirement planning support to help you build real wealth for the future
• Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
• Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage

Growth without limits:

• Professional development opportunities and clear career progression paths
• Mentorship from industry leaders who want to see you succeed
• Learning budget to invest in skills that matter to your future

A culture that energizes:

• People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation
• One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges
• We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results
• Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable

The practical stuff:

• Competitive base salary that rewards your success
• Unlimited PTO policy because rest and recharge time is non-negotiable
• Benefits effective day one—because you shouldn’t have to wait to be taken care of

Ready to create a healthier world? We're ready for you.

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $189,600 to $237,000. Note that compensation may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded

Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to talent@personifyhealth.com. All of our legitimate openings can be found on the Personify Health Career Site.

Application Deadline: Open until position is filled.