Humana is looking for a Behavioral Health Medical Director to drive behavioral health care strategy and operations for our Medicare line of business. You will leverage your medical background to make critical determinations on service authorization, level of care, and site of service while supporting our mission to put health first.
What You'll Do
- Actively use your medical background and judgement to make determinations on authorizing requested services, level of care, and site of service.
- Operationalize Medicare, Medicare Advantage, and Medicaid requirements in your daily work, guided by national clinical guidelines and CMS policies.
- Develop and present educational seminars on various behavioral health topics to the clinical operations team and broader organization.
- Perform computer-based review of moderately complex to complex clinical scenarios and review all submitted clinical records.
- Communicate decisions to internal associates and participate in care management; prioritize daily work effectively.
- Discuss cases with external physicians by phone to gather clinical information or discuss determinations, sometimes requiring conflict resolution.
- Speak with external physicians, groups, and facilities to support regional market priorities, focusing on collaborative relationships, value-based care, and quality metrics.
- Develop procedures, processes, and new delivery models to maintain efficient operations while ensuring quality of care and financial goals.
- Support Humana values and Humana's Bold Goal mission throughout all activities.
What We're Looking For
- MD or DO degree.
- Must be board certified in Psychiatry.
- 5+ years of direct clinical patient care experience post residency or fellowship.
- Current and ongoing Board Certification in an approved ABMS Medical or ABPN Specialty.
- A current and unrestricted license in at least one jurisdiction and willingness to obtain additional licenses if required.
- No current sanctions from Federal or State Governmental organizations, and able to pass credentialing requirements.
- Excellent verbal and written communication skills.
- Evidence of analytic and interpretation skills, with prior experience on teams focusing on quality management, utilization management, case management, discharge planning, and/or home health or post-acute services.
Nice to Have
- Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid products.
- Utilization management experience in a medical management review organization.
- Experience with national guidelines such as MCG®, ASAM, or InterQual.
- Advanced degree such as an MBA, MHA, or MPH.
- Exposure to Public Health, Population Health, analytics, and the use of business metrics.
- Experience working with Case managers on complex case management, including familiarity with social determinants of health.
- The curiosity to learn, the flexibility to adapt, and the courage to innovate.
Team & Environment
Typically reports to an Associate Vice President of Health Services, Lead, or Corporate Medical Director, depending on the size of the region or line of business.
Benefits & Compensation
- Compensation: $223,800 - $313,100 per year.
- Medical, dental and vision benefits.
- 401(k) retirement savings plan.
- Time off including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave.
- Short-term and long-term disability.
- Life insurance.
Work Mode
This is a remote position.
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.
