Humana Behavioral Health Medical Director - Medicaid Montpelier, Vermont
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. The work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Position Responsibilities:
- Uses their medical background, experience, and judgment to make determinations whether requested services, requested level of care, or requested site of service should be authorized, with all work occurring within a context of regulatory compliance and assisted by diverse resources.
- Learns Medicaid requirements and understands how to operationalize this knowledge in daily work.
- Conducts computer-based reviews of moderately complex to complex clinical scenarios, reviews submitted clinical records, prioritizes daily work, communicates decisions to internal associates, and may participate in care management.
- Conducts discussions with external physicians to gather additional clinical information or discuss determinations through the peer-to-peer process.
- May speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities.
- Supports Humana values and our enterprise social needs team mission throughout all activities.
- Flows to work as needed within the cluster for vacations, weekends, and holidays coverage.
Reporting Relationship:
This position reports directly to the Cluster Lead Medical Director.
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, 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. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family.
About Us:
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company.
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 veteran status.
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