Become a part of our caring community and help us put health first
 

Humana Healthy in Virginia is in search of a Behavioral Health Medical Director who will oversee our behavioral health (BH) clinical program for Medicaid members in Virginia. They will collaborate closely with the Associate VP, Clinical Services, the Director, BH & Addictions and Recovery Treatment Services (ARTS), and the Chief Medical Officer (CMO) to integrate the day‐to‐day administration and strategic management of behavioral and physical health services, including Care Management (CM), Utilization Management (UM), Quality Improvement, and value‐based payment programs. The Behavioral Health Director will be based in Virginia and will also lead the development of new products and services in Humana’s Medicaid BH delivery model.

               

• Leads clinical and quality management components of Humana’s BH services.
• Oversees, monitors, and assists with the management of psychopharmacology pharmacy benefits manager (PBM) activities, including the establishment of prior authorization, clinical appropriateness of use, and step therapy requirements for the use of stimulants and antipsychotics for all Members; consultations and clinical guidance for contracted primary care Providers (PCPs) treating behavioral health‐related concerns not requiring referral to behavioral health specialists.
• Develops comprehensive care programs for the management of youth and adult behavioral health concerns typically treated by PCPs, such as ADHD and depression.
• Develops targeted education and training for contracted PCPs to screen for mental health and substance use disorders (SUD) using evidence‐based tools (e.g., AUDIT‐C, PHQ‐9 and GAD‐7), performs diagnostic assessments, provide counseling and prescribes pharmacotherapy when indicated, and builds collaborative care models in their practices.
• Coordinates with the Medical Director to integrate the administration and management of behavioral and physical health services.
• Oversees, monitors, and assists with effective implementation of the Quality Management (QM) program; and works closely with the Care Management (CM), ARTS, Utilization Management (UM) of services and associated appeals related to children and youth and adults with mental illness and/or SUD.
• Leads BH policy development in Virginia, driving implementation, oversight, and accountability for both Humana internal and external stakeholders including but not limited to the Department of Virginia Medical Assistance (DMAS), Department of Behavioral Health and Developmental Services (DBHDS) and the Virginia Department of Health (VDH).
• Adheres to and complies with federal and Commonwealth laws and programmatic requirements.
• Collaborates with Provider relations personnel to ensure high‐quality and appropriate care delivered through the BH Provider network.
• Establishes and maintains relationships with Providers, advocates, and other key Virginia stakeholders by maintaining open and ongoing communications; represents Humana at public forums and engagement opportunities.
• Maintains compliance with BH‐related Contract requirements and attends oversight committee meetings to ensure appropriate procedures are adhered to within Humana and within care delivery.
• Collaborates closely with corporate and local Population Health teams in developing programs and strategies to address BH needs at a population health level.

Use your skills to make an impact
 

Required Qualifications

• Physician with a current, unencumbered Virginia‐license board‐certified in psychiatry.
• Must reside in the Commonwealth of Virginia or willing to relocate to the Commonwealth of Virginia by contract go-live date.
• Minimum five (5) years or more clinical experience working in behavioral health.
• Knowledge of the managed care industry.
• Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, CM, UM, discharge planning and/or home health or rehabilitation.
• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Preferred Qualifications

• Familiarity with Virginia‐based BH organizations.
• Medicaid Managed Care clinical or behavioral health leadership experience.

Additional Information

• Workstyle:  Hybrid Home - Associates Home office environment is their primary work location where the majority of their work week will be spent, but they will use Humana office space occasionally for collaboration and other face-to-face needs. The Humana Healthy Horizons Virginia office is in Glen Allen, Virginia.
• Typical Workdays