Behavioral Health Medical Director, Medicaid

Humana

Behavioral Health Medical Director responsible for Medicaid operations and clinical decision-making in a remote setting. Collaborating with teams and external physicians to provide effective care management.

Posted 6/16/2026full-timeRemote • Florida, Kentucky, Louisiana, Ohio, Oklahoma, Virginia • 🇺🇸 United StatesLead💰 $223,800 - $313,100 per yearWebsite

About the role

Key responsibilities & impact

Use 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
Learn Medicaid requirements and understand how to operationalize this knowledge in your daily work assigned cluster
Work 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
Conducts discussions with external physicians by phone to gather additional clinical information or discuss determinations through the peer-to-peer process
May speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities
Supports Humana values including working collaboratively on a team throughout all activities
Flows to work as needed within cluster as needed for vacations, weekends and holidays coverage.

Requirements

What you’ll need

Doctor of Medicine or Doctor of Osteopathy
Board-certified in Psychiatry (ABPN) approved by ABMS
A current and unrestricted Physician license in at least one of the states that are part of the specific cluster (Louisiana, Oklahoma, Indiana, Ohio, Florida, Virginia, Kentucky) 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.

Benefits

Comp & perks

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

ATS Keywords

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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 reviewclinical records reviewMedicaid requirementspeer-to-peer processclinical services

Soft Skills

communicationcollaborationjudgmentprioritization

Certifications

Doctor of MedicineDoctor of OsteopathyBoard-certified in Psychiatry