Behavioral Health Medical Director, Medicaid

🔥 0 minutes ago

🐊 Florida, Kentucky, +4 more states – Remote

🐊 Florida – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote ⚔️ Virginia – 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

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

• Use your medical background, experience, and judgement to make determinations whether requested services, requested level of care, or requested site of service should be authorized, with all work occurring within a context of regulatory compliance and assisted by diverse resources • Learn Medicaid requirements and understand how to operationalize this knowledge in your daily work assigned cluster • Work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management • Conducts discussions with external physicians by phone to gather additional clinical information or discuss determinations through the peer-to-peer process • May speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities • Supports Humana values including working collaboratively on a team throughout all activities • Flows to work as needed within cluster as needed for vacations, weekends and holidays coverage.

🎯 Requirements

• Doctor of Medicine or Doctor of Osteopathy • Board-certified in Psychiatry (ABPN) approved by ABMS • A current and unrestricted Physician license in at least one of the states that are part of the specific cluster (Louisiana, Oklahoma, Indiana, Ohio, Florida, Virginia, Kentucky) and willing to obtain additional license, if required • At least five years of experience post-training providing clinical services • Experience in utilization management review and case management in a health plan setting • No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.

🏖️ 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