Medical Director Behavioral Health, Medicaid

Responsibilities

• Use medical background and experience to determine authorization of requested services, level of care, and site of service.
• Operate under regulatory compliance and utilize diverse resources such as national clinical guidelines, state policies, CMS policies, and clinical reference materials.
• Review and prioritize clinical scenarios using computer-based tools, review submitted clinical records, and communicate decisions to internal associates.
• Communicate with external physicians via phone to gather clinical information or resolve determinations through the peer-to-peer process.
• Engage with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities.
• Collaborate on team activities to support Humana values including working collaboratively on a team throughout all activities.

Requirements

• Doctor of Medicine or Doctor of Osteopathy, board-certified in an ABMS recognized specialty of Psychiatry.
• A current and unrestricted license in at least one jurisdiction and willingness to obtain additional licenses if required.
• At least five years of experience post-training providing clinical services.
• No current sanctions from Federal or State Governmental organizations, and able to pass credentialing requirements.
• SSN request is a reference check task that scans for duplicate profiles in our Workday ATS.

Preferred Experience

• Experience with Medicaid enrollees, providers, and stakeholders in a clinical or administrative setting.
• Experience with accreditation process (NCQA).
• Experience with CGX and MHK.
• Licensure through the Interstate Medical Licensure Compact.
• Experience with application of MCG and ASAM criteria.

License/Credential Requirement

Physician with an active, unencumbered license in at least one of the states that are part of the specific cluster (Louisiana, Oklahoma, Indiana, Ohio, Florida, Virginia, Kentucky).

About Us

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

Humana is committed to equal opportunity employment and does not discriminate against employees or applicants 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 disabilities or protected veteran status, and to base all employment decisions only on valid job requirements.