About Cambia Health Solutions

Cambia Health Solutions is a health insurance organization dedicated to creating a person-focused and economically sustainable healthcare system. With more than 100 years of history, the company partners with providers, members, and communities to improve healthcare quality, accessibility, and outcomes through innovation and clinical excellence.

The Role

The Associate Medical Director / Medical Director provides executive clinical leadership for behavioral health utilization management across multiple lines of business. Working with cross-functional leaders, the role oversees clinical review processes, develops behavioral health policies, and ensures high-quality, evidence-based care while maintaining regulatory compliance.

This position partners with internal leadership and external providers to improve behavioral health outcomes, optimize utilization management programs, and support the organization's long-term healthcare transformation initiatives.

Key Responsibilities

Clinical Leadership

• Provide clinical oversight for behavioral health utilization management activities.
• Conduct prior authorization, appeal, and post-service medical reviews.
• Perform physician case reviews requiring medical judgment.
• Provide peer-to-peer consultations with healthcare providers.

Strategy & Program Development

• Assist in developing behavioral health policies and utilization management programs.
• Support long-term planning, goals, and strategic initiatives for integrated behavioral health services.
• Monitor program performance and implement operational improvements.

Operations

• Oversee behavioral health operational policies, procedures, and standards.
• Monitor utilization trends and recommend process improvements.
• Ensure safe, effective, and cost-efficient behavioral health services.

Collaboration

• Partner with the Executive Medical Director of Behavioral Health and cross-functional teams.
• Participate in medical policy development and quality improvement initiatives.
• Communicate utilization management decisions with providers and stakeholders.
• Stay current on healthcare regulations, medical advancements, and industry trends.

Qualifications

• MD or DO degree.
• Active, unrestricted medical license in Oregon, Washington, Idaho, or Utah.
• Board Certification in General Psychiatry or Child Psychiatry (both preferred).
• Minimum of 3 years of clinical experience.
• Minimum of 2 years of health plan utilization management and/or case management experience.
• Strong knowledge of behavioral health treatment and utilization management.
• Experience collaborating with hospitals, provider groups, or integrated delivery systems.
• Strong communication, leadership, and relationship management skills.
• Experience with healthcare regulations, reimbursement models, and population health.
• Experience using AI tools to improve productivity is highly desirable.

Preferred Qualifications

• Board certification in both General Psychiatry and Child Psychiatry.
• Experience conducting medical case reviews.
• Knowledge of health insurance regulations, parity legislation, and accountable care models.
• Leadership experience managing clinical teams or healthcare initiatives.

Compensation

Associate Medical Director

• Expected hiring range: $217,600 – $294,400 annually
• Bonus target: 25%

Medical Director

• Expected hiring range: $238,850 – $323,150 annually
• Bonus target: 30%

Time Commitment

• Part-time
• Maximum of 12 hours per week

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