Behavioral Health Medical Director – Medicare

November 11

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Humana

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Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

📋 Description

• responsible for behavioral health care strategy and/or operations • actively uses medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized • work occurs within a context of regulatory compliance and assisted by diverse resources • attend and participate in meetings involving care management, provider relations, quality of care, audit, grievance and appeal and policy review • develop and present educational seminars on various behavioral health topics to the clinical operations team and healthcare organization • includes computer based review of clinical scenarios, review of submitted clinical records, communication of decisions to internal associates • speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities

🎯 Requirements

• MD or DO degree • Must be board certified in Psychiatry • 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare or Medicaid type population • Current and ongoing Board Certification in an approved ABMS Medical or ABPN Specialty • A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required • No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements • Excellent verbal and written communication skills • Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation

🏖️ Benefits

• medical, dental and vision benefits • 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 • many other opportunities