Description
We are seeking a Behavioral Health Medical Director to join our team. As a Behavioral Health Medical Director, you will be responsible for behavioral health care strategy and/or operations. You will work on moderately complex to complex issues, analyzing situations or data that require an in-depth evaluation of variable factors.
Your responsibilities will include:
- Developing procedures, processes, productivity targets, and new delivery models
- Maintaining efficient operations while ensuring attainment of quality of care and financial goals
- Providing information for pricing guidelines based on utilization patterns and client demographics
- Making decisions on moderately complex to complex issues regarding technical approach for project components
You will actively use your medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs within a context of regulatory compliance, and you will be assisted by diverse resources, including national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise.
As a Behavioral Health Medical Director, you will learn Medicare, Medicare Advantage, and/or Medicaid requirements and understand how to operationalize this knowledge in your daily work. You may also speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management.
Requirements:
- MD or DO degree
- 5+ years of direct clinical patient care experience post-residency or fellowship
- Current and ongoing Board Certification in an approved ABMS Medical or ABPN Specialty
- A current and unrestricted license in at least one jurisdiction
- Excellent verbal and written communication skills
- Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning, and/or home health or post-acute services
Preferred Qualifications:
- Knowledge of the managed care industry, including Medicare Advantage, Managed Medicaid, and/or Commercial products
- Utilization management experience in a medical management review organization
- Experience with national guidelines such as MCG or InterQual
- Psychiatry, Internal Medicine, Family Practice, Geriatrics, Hospitalist, or Emergency Medicine clinical specialists
- Advanced degree such as an MBA, MHA, MPH
- Exposure to Public Health, Population Health, analytics, and use of business metrics
Work Arrangements:
- Remote work arrangement available
- Occasional travel to Humana's offices for training or meetings may be required
Salary and Benefits:
- Salary range: $223,800 - $313,100 per year
- Eligible for a bonus incentive plan
- Competitive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and short-term and long-term disability