Behavioral Health Medical Director

MUST RESIDE IN OKLAHOMA OR SOUTHWEST REGION ON THE UNITED STATES.

The Behavioral Health Medical Director responsible for Behavioral Health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Position Responsibilities:

· Uses their 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, which may include national clinical guidelines, state policies, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources

· Learns Medicaid requirements and understands how to operationalize this knowledge in their daily work in their assigned cluster (Southwest cluster currently serves Louisiana and Oklahoma)

· 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, with clinical scenarios arising from outpatient or inpatient environments

· Conducts discussions with external physicians by phone to gather additional clinical information or discuss determinations through the peer-to-peer process, and in some instances, these may require conflict resolution skills

· May speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes and a focus on collaborative business relationships, value-based care, population health, or disease or care management

· Supports Humana values and our enterprise social needs team mission throughout all activities

· Flows to work as needed within cluster as needed for vacations, weekends and holidays coverage

Reporting Relationship:

This position reports directly to the Cluster Lead Medical Director.

Use your skills to make an impact

REQUIREMENTS:

· Doctor of Medicine or Doctor of Osteopathy

· Board-certified in ABMS or ABPN recognized specialty

· 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

• Must obtain or have Oklahoma medical license.

· 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

· Resides in Oklahoma

· Child/adolescent psychiatry fellowship.

Job Type: Full-time

Pay: $290,000.00 - $300,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Supplemental pay types:

• Bonus opportunities

Experience:

• post-training providing clinical services.: 5 years (Required)
• utilization management review and case management: 2 years (Required)
• Child/adolescent psychiatry: 1 year (Required)

License/Certification:

• Board-certified in ABMS or ABPN recognized specialty. (Required)
• Doctor of Medicine or Doctor of Osteopathy (Required)

Work Location: Remote