Behavioral Health Medical Director

Humana • Louisiana, MO

1d • $223,800 - $313,100 • Remote

About The Position

The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. This role involves complex issues requiring in-depth analysis of variable factors. The Director may develop procedures, processes, productivity targets, and new delivery models, ensuring efficient operations while meeting quality of care and financial goals. They will provide information for pricing guidelines based on utilization patterns and client demographics. The role requires making decisions on moderately complex to complex issues regarding technical approach for project components, with work performed independently. The Behavioral Health Medical Director will use their medical background and judgment to authorize requested services, level of care, and site of service, ensuring regulatory compliance. This involves utilizing resources such as national clinical guidelines, CMS policies, clinical reference materials, and internal expertise. The Director will learn and operationalize Medicare, Medicare Advantage, and/or Medicaid requirements. They may also engage with external physicians, groups, facilities, or community groups to support regional market priorities, focusing on Humana processes, value-based care, population health, and disease or care management. The role supports Humana values and its Bold Goal mission.

Requirements

• MD or DO degree
• 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare or Medicaid type population
• Current and ongoing Board Certification an approved ABMS Medical or ABPN Specialty
• A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.
• No current sanction 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 participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.

Nice To Haves

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
• Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.
• Experience with national guidelines such as MCG® or InterQual
• Psychiatry, Internal Medicine, Family Practice, Geriatrics, Hospitalist, or Emergency Medicine clinical specialists
• Advanced degree such as an MBA, MHA, MPH
• Exposure to Public Health, Population Health, analytics, and use of business metrics.
• Experience working with Case managers or Care 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

Responsibilities

• Develop procedures, processes, productivity targets, and new delivery models.
• Maintain efficient operations while ensuring attainment of quality of care and financial goals.
• Provide information for pricing guidelines based on utilization patterns and client demographics.
• Make decisions on moderately complex to complex issues regarding technical approach for project components.
• Use medical background, experience, and judgment to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized.
• Learn Medicare, Medicare Advantage and/or Medicaid requirements, and operationalize this knowledge in daily work.
• Speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities.
• Support Humana values, and Humana’s Bold Goal mission, throughout all activities.

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree