Behavioral Health Medical Director

Humana

Behavioral health medical director guiding Humana’s insurance-based care authorization and population health strategy. Applying clinical judgment to managed-care decisions and regional healthcare priorities.

Posted 8/13/2026full-timeRemote • Louisiana • 🇺🇸 United StatesLead💰 $223,800 - $313,100 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in leading behavioral health care strategy and operations, with a strong focus on regulatory compliance, quality management, and financial goals. Proficient in operationalizing Medicare, Medicaid, and value-based care initiatives while effectively communicating with healthcare providers and community groups.

Highest-signal resume keywords

MD Or DO Degree5+ Years Clinical Patient Care ExperienceCurrent Board CertificationUtilization Management ExperienceKnowledge Of Managed Care

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Behavioral Health Care StrategyQuality ManagementUtilization ManagementCase ManagementDischarge PlanningRegulatory ComplianceMedical JudgmentPopulation Health ManagementAnalytical SkillsClinical Specialization

Soft Skills

Excellent Communication SkillsTeam CollaborationAnalytical Thinking

Tools & Technologies

MCG GuidelinesInterQual Guidelines

Certifications & Qualifications

Current Medical LicenseBoard Certification

Industry Keywords

Medicare AdvantageManaged MedicaidHealth InsuranceIntegrated Delivery SystemsClinical Group Practice ManagementSocial Determinants Of HealthPublic HealthBusiness Metrics

About the role

Key responsibilities & impact

Lead behavioral health care strategy and/or operations
Develop procedures, processes, productivity targets, and new delivery models
Maintain efficient operations while achieving quality-of-care and financial goals
Provide information for pricing guidelines based on utilization patterns and client demographics
Make determinations on authorization of requested services, levels of care, and sites of service
Apply medical background and judgment within regulatory compliance requirements
Operationalize Medicare, Medicare Advantage, and/or Medicaid requirements in daily work
Communicate with contracted external physicians, physician groups, facilities, and community groups
Support regional market priorities, collaborative business relationships, value-based care, population health, and disease or care management
Support Humana values and its Bold Goal mission
Report typically to a Regional Vice President of Health Services, Lead, or Corporate Medical Director

Requirements

What you’ll need

MD or DO degree
5+ years of direct clinical patient care experience after residency or fellowship
Current and ongoing board certification in an approved ABMS Medical or ABPN specialty
Current and unrestricted medical license in at least one jurisdiction, with willingness to obtain additional licensure if required
No current sanction from federal or state governmental organizations
Ability to pass credentialing requirements
Excellent verbal and written communication skills
Analytical and interpretation skills
Prior experience participating in teams focused on quality management, utilization management, case management, discharge planning, and/or home health or post-acute services
Preferred: knowledge of managed care, Medicare Advantage, Managed Medicaid, commercial products, hospitals, integrated delivery systems, health insurance, healthcare providers, or clinical group practice management
Preferred: utilization management experience in a medical management review organization
Preferred: experience with MCG or InterQual national guidelines
Preferred: clinical specialization in Psychiatry, Internal Medicine, Family Practice, Geriatrics, Hospitalist, or Emergency Medicine
Preferred: advanced degree such as MBA, MHA, or MPH
Preferred: exposure to public health, population health, analytics, and business metrics
Preferred: experience with case or care managers on complex case management and familiarity with social determinants of health
Ability to work from a dedicated space without ongoing interruptions
Home internet with at least 25 Mbps download and 10 Mbps upload speed
Occasional travel to Humana offices for training or meetings may be required

Benefits

Comp & perks

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