Behavioral Health Medical Director

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Oversee the strategy and operations of behavioral health care.

• Create and implement procedures, processes, productivity targets, and innovative delivery models.

• Ensure operational efficiency while meeting quality-of-care and financial objectives.

• Provide pricing guideline information based on client utilization patterns and demographics.

• Make decisions regarding the authorization of requested services, levels of care, and service locations.

• Utilize medical expertise and judgment while adhering to regulatory compliance standards.

• Implement Medicare, Medicare Advantage, and/or Medicaid guidelines in day-to-day operations.

• Engage with contracted external physicians, physician groups, facilities, and community organizations.

• Promote regional market priorities, foster collaborative business relationships, support value-based care, population health, and disease or care management initiatives.

• Uphold Humana's values and contribute to its Bold Goal mission.

• Typically report to a Regional Vice President of Health Services, Lead, or Corporate Medical Director.

⛳️ Requirements

• MD or DO degree.

• A minimum of 5 years of direct clinical patient care experience post-residency or fellowship.

• Active and ongoing board certification in an accredited ABMS Medical or ABPN specialty.

• A current and unrestricted medical license in at least one jurisdiction, with a willingness to obtain additional licenses if necessary.

• No existing sanctions from federal or state governmental entities.

• Capability to meet credentialing requirements.

• Strong verbal and written communication skills.

• Proficient analytical and interpretation skills.

• Previous involvement in teams dedicated to quality management, utilization management, case management, discharge planning, or home health/post-acute services.

• Preferred: familiarity with managed care, Medicare Advantage, Managed Medicaid, commercial products, hospitals, integrated delivery systems, health insurance, or clinical group practice management.

• Preferred: experience in utilization management within a medical management review organization.

• Preferred: knowledge of MCG or InterQual national guidelines.

• Preferred: clinical specialization in Psychiatry, Internal Medicine, Family Practice, Geriatrics, Hospitalist, or Emergency Medicine.

• Preferred: an advanced degree such as MBA, MHA, or MPH.

• Preferred: experience in public health, population health, analytics, and business metrics.

• Preferred: collaboration with case or care managers in complex case management and awareness of social determinants of health.

• Ability to work from a dedicated and uninterrupted space.

• Home internet connection with a minimum of 25 Mbps download and 10 Mbps upload speed.

• Occasional travel to Humana offices for training or meetings may be necessary.

🏝️ 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.