Humana

Medical Director – BH/MH

Humana

full-time

Posted on:

Location Type: Remote

Location: Florida • Kentucky • United States

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Salary

💰 $223,800 - $313,100 per year

Job Level

Lead

About the role

  • Responsible for behavioral health care strategies and/or operations
  • Make determinations whether requested services, requested level of care, or requested site of service should be authorized
  • Work includes computer-based review of moderately complex to complex clinical scenarios
  • Conduct discussions with external physicians by phone to gather additional clinical information or discuss determinations
  • Support regional market priorities
  • Report directly to the Lead Behavioral Health Medical Director

Requirements

  • Doctor of Medicine or Doctor of Osteopathy
  • Board-certified in ABMS or ABPN recognized specialty of Psychiatry
  • A current and unrestricted license in at least one jurisdiction 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
  • Preferred: Experience working with Medicaid Enrollees, providers, and stakeholders in a clinical or administrative setting
  • Experience with accreditation process (NCQA)
  • Experience with CGX and MHK
  • Has licensure through the Interstate Medical Licensure Compact
  • Has a Virginia medical license
  • Has experience with application of MCG and ASAM criteria
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
  • many other opportunities
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
utilization management reviewcase managementclinical servicesaccreditation processMCG criteriaASAM criteria
Soft Skills
communicationcollaboration
Certifications
Doctor of MedicineDoctor of OsteopathyBoard-certified in ABMSBoard-certified in ABPN