Behavioral Health Medical Director

🔥 0 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $223.8k - $313.1k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • 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.

📋 Description

• Lead behavioral health care strategy and/or operations • Develop procedures, processes, productivity targets, and new delivery models • Maintain efficient operations while achieving quality-of-care and financial goals • Provide information for pricing guidelines based on utilization patterns and client demographics • Make determinations on authorization of requested services, levels of care, and sites of service • Apply medical background and judgment within regulatory compliance requirements • Operationalize Medicare, Medicare Advantage, and/or Medicaid requirements in daily work • Communicate with contracted external physicians, physician groups, facilities, and community groups • Support regional market priorities, collaborative business relationships, value-based care, population health, and disease or care management • Support Humana values and its Bold Goal mission • Report typically to a Regional Vice President of Health Services, Lead, or Corporate Medical Director

🎯 Requirements

• MD or DO degree • 5+ years of direct clinical patient care experience after residency or fellowship • Current and ongoing board certification in an approved ABMS Medical or ABPN specialty • Current and unrestricted medical license in at least one jurisdiction, with willingness to obtain additional licensure if required • No current sanction from federal or state governmental organizations • Ability to pass credentialing requirements • Excellent verbal and written communication skills • Analytical and interpretation skills • Prior experience participating in teams focused on quality management, utilization management, case management, discharge planning, and/or home health or post-acute services • Preferred: knowledge of managed care, Medicare Advantage, Managed Medicaid, commercial products, hospitals, integrated delivery systems, health insurance, healthcare providers, or clinical group practice management • Preferred: utilization management experience in a medical management review organization • Preferred: experience with MCG or InterQual national guidelines • Preferred: clinical specialization in Psychiatry, Internal Medicine, Family Practice, Geriatrics, Hospitalist, or Emergency Medicine • Preferred: advanced degree such as MBA, MHA, or MPH • Preferred: exposure to public health, population health, analytics, and business metrics • Preferred: experience with case or care managers on complex case management and familiarity with social determinants of health • Ability to work from a dedicated space without ongoing interruptions • Home internet with at least 25 Mbps download and 10 Mbps upload speed • Occasional travel to Humana offices for training or meetings may be required

🏖️ Benefits

• Bonus incentive plan • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Home-based work arrangement