Behavioral Health Medical Director, Medicaid

Become a part of our caring community. The Behavioral Health Medical Director is responsible for behavioral health care strategies and/or operations. The position is based virtually in one of the following states: FL; KY; IN; LA; OH; OK; VA . The work schedule is 8 am to 5 pm EST. Responsibilities Use your medical background, experience, and judgement to determine whether requested services, level of care, or site of service should be authorized, ensuring regulatory compliance and utilizing resources such as clinical guidelines, state policies, CMS determinations, and reference materials. Learn Medicaid requirements and operationalize this knowledge in daily work within the assigned cluster. Conduct computer-based reviews of moderately complex to complex clinical scenarios, review submitted clinical records, prioritize daily work and communicate decisions to internal associates; participate in care management as needed. Hold discussions with external physicians by phone to gather additional clinical information or discuss determinations via the peer-to-peer process, applying conflict resolution skills when required. Engage contracted external physicians, physician groups, facilities or community groups to support regional market priorities and Humana processes, focusing on collaborative business relationships, values-based care, and population health. Support Humana values, working collaboratively on a team throughout all activities and flow working as needed within the cluster for vacations, weekends and holidays coverage. Requirements Doctor of Medicine (MD) or Doctor of Osteopathy (DO) with board certification in Psychiatry (ABPN) approved by ABMS. A current and unrestricted physician license in at least one of the cluster states (Louisiana, Oklahoma, Indiana, Ohio, Florida, Virginia, Kentucky) and willingness to obtain additional licenses if required. At least five years of post-training experience providing clinical services. Experience in utilization management review and case management in a health-plan setting. No current sanctions from federal or state governmental organizations, and ability 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. Licensure through the Interstate Medical Licensure Compact. Medical license in Louisiana. Experience applying MCG and ASAM criteria. Pay Range $223,800-313,100 per year (full time 40 hours per week). The compensation range may vary by location and based on demonstrated skills, knowledge, experience, education, and certifications. This role is eligible for a bonus incentive plan. Benefits Humana provides medical, dental and vision benefits, a 401(k) retirement savings plan, paid time off including company and personal holidays, volunteer time off, paid parental and caregiver leave, short-term and long-term disability, life insurance and many other opportunities. Travel This is a remote position; however, occasional travel to Humana offices for training or meetings may be required. 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. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. #J-18808-Ljbffr Humana Inc