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The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Behavioral Health Medical Director may develop procedures, processes, productivity targets, and new delivery models. Maintains efficient operations while ensuring attainment of quality of care and financial goals. Provides information for pricing guidelines based on utilization patterns and client demographics. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.

The Behavioral Health Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise.

The Behavioral Health Medical Directors will learn Medicare, Medicare Advantage and/or Medicaid requirements, and will understand how to operationalize this knowledge in their daily work.

The Behavioral Health Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management. The Behavioral Health Medical Directors support Humana values, and Humana’s Bold Goal mission, throughout all activities.

Candidates can reside anywhere in the continental USA - working EST zone hours, 8am-5pm

Use your skills to make an impact
 

Required Qualifications

• 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

• Active Board Certification; The American Board of Psychiatry and Neurology, Inc. (ABPN) 

• 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.

Preferred

• 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. 

Additional Information

This is not a leadership role, and you will not have any direct reports, typically reports to the Lead Corporate Medical Director.

You will conduct Utilization Management of the care received by members in an assigned market, member population, or condition type.

Some medical directors may join a centralized team for several months after training, until positions become available for specific markets.

May participate on project teams or organizational committees.

Work at Home Guidance

To ensure Home or Hybrid Home/Office asso