Behavioral Health Medical Director, Medicaid
Location
Florida + 5 moreAll locations: Florida | Kentucky | Louisiana | Ohio | Oklahoma | Virginia
Posted
2 days ago
Salary
$223.8K - $313.1K / year
Seniority
Lead
Job Description
Behavioral Health Medical Director, Medicaid
Humana
• 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.
Job Requirements
- 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
- 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
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