Humana Behavioral Health Medical Director - Medicaid Des Moines, Iowa
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 operations. The role involves moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Position Responsibilities:
- Utilizes medical background, experience, and judgment to make determinations regarding requested services, levels of care, or sites of service within a context of regulatory compliance.
- Learns Medicaid requirements and operationalizes this knowledge in daily work.
- Conducts computer-based reviews of clinical scenarios, prioritizes work, and communicates decisions to internal associates.
- Engages with external physicians to gather clinical information and discuss determinations.
- May support regional market priorities through discussions with contracted external physicians and community groups.
- Supports Humana values and enterprise social needs team mission throughout all activities.
- Provides coverage as needed within the cluster for vacations, weekends, and holidays.
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 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 (5) 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, FLORIDA, 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 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. $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. offers competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, paid time off, short-term and long-term disability, life insurance, and more.
About us: Humana Inc. (NYSE: HUM) is committed to putting health first for our teammates, customers, and company.
Equal Opportunity Employer: Humana does not 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.
#J-18808-Ljbffr
