BH Medical Director (Medicaid)

Location: Fully remote, work at home in Illinois. Standard hours are Monday through Friday, 8:00 a.m. to 5:00 p.m., aligned with Eastern or Central Time. Rotating holiday and on-call coverage may be required; limited travel to hirify.global offices for training or meetings may occur.

Salary: $223,800–$313,100 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services to people with Medicare, Medicaid, families, individuals, and communities.

What you will do

• Provide clinical leadership for Medicaid behavioral health utilization management, primarily supporting Illinois Medicaid and potentially other Medicaid markets.
• Review complex behavioral health requests across levels of care and specialty services and make timely, consistent, defensible medical-necessity determinations.
• Apply evidence-based national guidelines, state regulations, Medicaid requirements, and independent clinical judgment.
• Conduct peer-to-peer consultations and support appeals, provider disputes, state fair hearings, audits, quality reviews, and regulatory activities.
• Collaborate with providers and internal partners on case consultations, training, and process improvement.
• Manage high-volume, time-sensitive work while maintaining confidentiality, compliance, credentialing, and privacy requirements.

Requirements

• MD or DO degree and board certification in psychiatry through the ABPN or another recognized certifying board.
• Active, unrestricted Illinois medical license at the time of hiring, with the ability to obtain and maintain additional state licenses as needed.
• At least five years of post-training clinical experience.
• Experience in utilization management, medical-necessity review, peer review, or comparable clinical decision-making.
• Strong written and verbal communication, clinical analysis, interpretation, conflict-resolution, and workload-management skills.
• Eligibility to participate in federal and state healthcare programs and ability to meet employment onboarding requirements.

Nice to have

• Two or more years of recent utilization management, medical-necessity review, or physician review experience in a health plan or managed care organization.
• Prior experience as a medical director, associate medical director, or physician reviewer.
• Knowledge of Medicaid requirements, state regulations, and evidence-based national guidelines.
• Experience with complex peer-to-peer reviews, appeals, provider disputes, fair hearings, quality reviews, or regulatory audits.
• Experience in addiction psychiatry, child and adolescent psychiatry, autism services, applied behavior analysis, or complex behavioral health needs.

Culture & Benefits

• Full-time employment with a 40-hour scheduled workweek.
• Fully remote work from a dedicated space that protects member PHI and HIPAA information.
• Minimum home internet requirements of 25 Mbps download and 10 Mbps upload.
• Medical, dental, and vision benefits, 401(k), paid time off, holidays, parental and caregiver leave, disability coverage, and life insurance.
• Team-based, collaborative work with rotating holiday and on-call coverage.

Hiring process

• Initial application prescreen followed by an on-demand HireVue assessment of approximately 10–15 minutes.
• Successful candidates proceed to subsequent interview rounds.
• Formal offers require entering an SSN into the Workday applicant tracking system for duplicate-profile screening.