Humana Behavioral Health Medical Director - Medicaid Topeka, Kansas
Become a part of our caring community and help us put health first
The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. This position involves moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Position Responsibilities:
- Uses medical background, experience, and judgment to determine whether requested services, level of care, or site of service should be authorized, ensuring regulatory compliance with diverse resources.
- Learns Medicaid requirements and operationalizes this knowledge in daily work.
- Conducts computer-based reviews of complex clinical scenarios, prioritizes daily work, and communicates decisions to internal associates.
- Engages in discussions with external physicians to gather clinical information or discuss determinations through the peer-to-peer process.
- May communicate with contracted external physicians, physician groups, or community groups to support regional market priorities.
- Supports Humana values and the enterprise social needs team mission throughout all activities.
- Flows to work as needed within the cluster for coverage.
Reporting Relationship:
This position reports directly to the Cluster Lead Medical Director.
Use your skills to make an impact
REQUIREMENTS:
- Doctor of Medicine or Doctor of Osteopathy.
- Board certified in Psychiatry.
- Board-certified in an ABMS or ABPN recognized specialty.
- A current and unrestricted license in at least one jurisdiction and willing to obtain additional licenses if required.
- At least five years of experience post-training providing clinical services.
- Experience in utilization management review and case management in a health plan setting.
- MUST HAVE ONE OF THE FOLLOWING STATE LICENSES AND/OR BE ABLE TO OBTAIN: OKLAHOMA, LOUISIANA, FLORIDA, OHIO, INDIANA, AND VIRGINIA.
- No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
Preferred:
- Experience working with Medicaid Enrollees, providers, and stakeholders in a clinical or administrative setting.
- Experience with the accreditation process (NCQA).
- Experience with CGX and MHK.
Scheduled Weekly Hours: 40
Pay Range: The compensation range below reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment. 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. $219,400 - $301,800 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.
Description of Benefits:
Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being. Benefits include medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance, and many other opportunities.
About Us:
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. We aim to make it easier for the millions we serve to achieve their best health.
Equal Opportunity Employer:
It is the policy of Humana not to discriminate against any employee or applicant for employment based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion.
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