[Hiring] Behavioral Health Medical Director @Humana

Role Description

The Behavioral Health Medical Director is 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.

• Support Humana’s values by working collaboratively and effectively within a team-based environment.
• Apply medical training, clinical experience, and professional judgment to determine whether requested services, levels of care, or sites of service should be authorized.
• Ensure all determinations are made within a regulatory compliance framework and are supported by appropriate resources, which may include:
  • National clinical guidelines
  • State policies
  • CMS policies and determinations
  • Clinical reference materials
  • Internal teaching conferences
  • Other applicable resources
• Learn and apply Medicaid requirements, including the ability to operationalize this knowledge in daily work within the assigned cluster.
• Perform computer-based reviews of moderately complex to complex clinical scenarios, including:
  • Review of all submitted clinical records
  • Prioritization of daily work
  • Communication of decisions to internal associates
  • Potential participation in care management activities
• Review clinical scenarios arising from both outpatient and inpatient care settings.
• Conduct telephone discussions with external physicians to obtain additional clinical information or discuss determinations through the peer-to-peer review process.
• Use conflict resolution skills when needed during physician discussions, particularly in complex or sensitive determination conversations.
• Engage with contracted external physicians, physician groups, facilities, or community organizations to support regional market priorities.
• Demonstrate an understanding of Humana processes and support collaborative business relationships, value-based care initiatives, population health strategies, and disease or care management programs as applicable.
• Provide coverage and flex across the assigned cluster as needed, including support for vacations, weekends, and holidays.

Qualifications

• Doctor of Medicine or Doctor of Osteopathy
• Board-certified in ABMS or ABPN recognized specialty of Psychiatry (Neurology not accepted)
• A current and unrestricted license through the Interstate Medical Licensure Compact in at least one jurisdiction and willing to obtain additional licenses when required
• No current sanction from Federal or State Governmental organizations, and able to pass onboarding requirements.
• 2+ years of project management experience
• At least five years of experience post-training providing clinical services
• Experience in utilization management review and case management in a health plan setting
• Excellent verbal and written communication skills with analytic and interpretative skills from prior experience focusing on quality, utilization, and/or case management
• Knowledge and experience with national guidelines such as NCD/LCD, MCG® or InterQual

Requirements

• Preferred experience working with Medicaid Enrollees, providers, and stakeholders in a clinical or administrative setting
• Experience with accreditation process (NCQA)
• Experience with CGX and MHK
• Has licensure through the Interstate Medical Licensure Compact (IMLC)
• Has an Indiana medical license
• Has experience with application of MCG and ASAM criteria

Benefits

• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parental Leave

Work Style

• Fully Remote
• Occasional travel to Humana's offices for training or meetings may be required.

Work Hours

• Typical business hours are Monday-Friday: 8 hours/day, 5 days/week EST zone and can sit anywhere in the US.
• There are holiday and weekend requirements for this role.
• Very minimal travel might be required for training, meetings, and/or conferences.

License/Credential Requirement

• At the time of hire, physician must have an active, unencumbered license in at least one of the states that are part of the specific cluster (Louisiana, Oklahoma, Indiana, Ohio, Florida, Virginia, Kentucky).

Reporting Relationship

• This position reports directly to the Cluster Lead Medical Director.

Pay Range

• The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
• $223,800 - $313,100 per year
• This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

• Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides 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 and many other opportunities.

Equal Opportunity Employer

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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.