Behavioral Health Medical Director, Medicaid

This is a fully remote position, open to applicants in Florida, +5 more states.

📋 Description

• Design and implement strategies and operations for behavioral health care.

• Assess whether to authorize requested services, levels of care, or locations of service.

• Make decisions within a framework of regulatory compliance utilizing clinical guidelines, state and CMS policies, and other relevant resources.

• Acquire knowledge and implement Medicaid requirements relevant to the assigned cluster.

• Conduct computer-based evaluations of moderately complex to complex clinical cases.

• Analyze submitted clinical records and prioritize daily tasks.

• Communicate decisions to internal team members and potentially engage in care management activities.

• Evaluate outpatient and inpatient clinical situations.

• Engage in telephone conversations with external physicians during peer-to-peer reviews.

• Apply conflict resolution skills in complex or sensitive discussions with physicians.

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

• Support regional market priorities, value-based care initiatives, population health strategies, and disease or care management programs.

• Provide coverage and flexibility across the assigned cluster, including during vacations, weekends, and holidays.

• Report directly to the Cluster Lead Medical Director.

⛳️ Requirements

• Doctor of Medicine or Doctor of Osteopathy degree.

• Board certification in an ABMS or ABPN recognized specialty of Psychiatry; Neurology is not accepted.

• Current and unrestricted license through the Interstate Medical Licensure Compact in at least one jurisdiction.

• Willingness to obtain additional licenses as necessary.

• No existing sanctions from Federal or State Governmental organizations.

• Capability to fulfill onboarding requirements.

• Over 2 years of project management experience.

• At least five years of post-training experience providing clinical services.

• Experience in utilization management review and case management within a health plan environment.

• Exceptional verbal and written communication skills.

• Strong analytical and interpretative skills with a focus on quality, utilization, and/or case management.

• Familiarity and experience with national guidelines such as NCD/LCD, MCG®, or InterQual.

• An active, unencumbered license in at least one state within the specific cluster at the time of hire: Louisiana, Oklahoma, Indiana, Ohio, Florida, Virginia, or Kentucky.

• Standard working hours are Monday to Friday, 8 hours per day, 5 days a week in the EST time zone.

• Ability to comply with work-from-home requirements, including a minimum internet connection of 25 Mbps download and 10 Mbps upload.

• Capability to work from a dedicated space free from interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

• Benefits commence on the first day of employment.

• Competitive 401k matching program.

• Generous accrual of Paid Time Off.

• Tuition Reimbursement available.

• Parental Leave provided.

• Comprehensive medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off, including company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance offered.

• Bonus incentive plan available.

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