[Hiring] Behavioral Health Medical Director @Humana

Role Description

The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The role involves moderately complex to complex issues requiring an in-depth evaluation of variable factors.

• Develop procedures, processes, productivity targets, and new delivery models.
• Maintain efficient operations while ensuring 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 approaches for project components.
• Utilize medical background, experience, and judgment to authorize requested services, levels of care, and sites of service.
• Work within a context of regulatory compliance, assisted by diverse resources including national clinical guidelines and CMS policies.
• Learn Medicare, Medicare Advantage, and/or Medicaid requirements and operationalize this knowledge in daily work.
• Engage 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.

Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care experience post-residency or fellowship, preferably in an inpatient environment and/or related to Medicare or Medicaid populations.
• Current and ongoing Board Certification in an approved ABMS Medical or ABPN Specialty.
• A current and unrestricted license in at least one jurisdiction, willing to obtain additional licenses if required.
• No current sanction from Federal or State Governmental organizations, able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills, with prior experience in quality management, utilization management, case management, discharge planning, and/or home health or post-acute services.

Requirements

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid, and/or Commercial products.
• Utilization management experience in a medical management review organization.
• Experience with national guidelines such as MCG® or InterQual.
• Clinical specialization in Psychiatry, Internal Medicine, Family Practice, Geriatrics, Hospitalist, or Emergency Medicine.
• Advanced degree such as an MBA, MHA, or 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.
• The curiosity to learn, the flexibility to adapt, and the courage to innovate.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance and many other opportunities.