Behavioral Health Medical Director

The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

• Develop procedures, processes, productivity targets, and new delivery models.
• Maintain efficient operations while ensuring attainment of quality of care and financial goals.
• Provide information for pricing guidelines based on utilization patterns and client demographics.
• Make determinations regarding technical approach for project components.
• Speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities.

Requirements

• MD or DO degree
• 5+ years of direct clinical patient care experience post residency or fellowship, preferably including inpatient experience and/or care of a Medicare or Medicaid type population
• Current and ongoing Board Certification
• A current and unrestricted license in at least one jurisdiction and willingness to obtain additional licenses if required
• No current sanctions from Federal or State Governmental organizations, and ability 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

Preferred Qualifications

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid, and/or Commercial products, or other Medical management organizations, hospitals/Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management
• Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance
• Experience with national guidelines such as MCG® or InterQual Psychiatry, Internal Medicine, Family Practice, Geriatrics, Hospitalist, or Emergency Medicine clinical specialists
• Advanced degree such as an MBA, MHA, 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, including familiarity with social determinants of health

About Us

Humana, Inc. is a leading U.S. healthcare company offering competitive benefits that support whole-person well-being. We provide medical, dental, and vision benefits, a 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. We are committed to equal opportunity employment and supporting the needs of our employees and their families.