Job Description
Become a part of our caring community and help us put health firstThe Behavioral Health Medical Director is responsible for behavioral health care strategies and/or operations. You will work assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.ResponsibilitiesUse 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, which may include national clinical guidelines, state policies, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sourcesLearn Medicaid requirements and understand how to operationalize this knowledge in your daily work assigned clusterWork 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, with clinical scenarios arising from outpatient or inpatient environmentsConducts discussions with external physicians by phone to gather additional clinical information or discuss determinations through the peer-to-peer process, and in some instances, these may require conflict resolution skillsMay speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes and a focus on collaborative business relationships, values-based care, population health, or disease or care managementSupports Humana values including working collaboratively on a team throughout all activitiesFlows to work as needed within cluster as needed for vacations, weekends and holidays coverageReporting RelationshipThis position reports directly to the Lead Behavioral Health Medical Director.Use your skills to make an impactRequirementsDoctor of Medicine or Doctor of OsteopathyBoard-certified in ABMS or ABPN recognized specialty of PsychiatryA current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if requiredAt least five years of experience post-training providing clinical servicesExperience in utilization management review and case management in a health plan settingNo current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.PreferredExperience working with Medicaid Enrollees, providers, and stakeholders in a clinical or administrative settingExperience with accreditation process (NCQA)Experience with CGX and MHKHas licensure through the Interstate Medical Licensure CompactHas a Virginia medical licenseHas experience with application of MCG and ASAM criteriaLicense/Credential RequirementPhysician 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).LocationThis role is based virtually in one of the states of the specific cluster.TravelWhile this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours40Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$223,800 - $313,100 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.Application Deadline: 09-09-2026About usHumana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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