Behavioral Health Medical Director, Medicaid
New
H
HumanaHealthcare, Managed Care
United States, EST zoneFull-TimeDirector
Salary$223,800 - $313,100 per year
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Job Details
- Experience
- At least five years of experience post-training providing clinical services; 2+ years of project management experience
- Required Skills
- Project Management
Requirements
- Doctor of Medicine (MD) or Doctor of Osteopathy (DO).
- Board-certified in Psychiatry (ABMS or ABPN recognized specialty; Neurology not accepted).
- Current and unrestricted license through the Interstate Medical Licensure Compact in at least one jurisdiction.
- Active, unencumbered license in at least one of these specific states: Louisiana, Oklahoma, Indiana, Ohio, Florida, Virginia, or Kentucky.
- At least five years of clinical experience post-training.
- Minimum of 2 years of project management experience.
- Proven experience in utilization management review and case management within a health plan setting.
- Knowledge of and experience with national clinical guidelines such as NCD/LCD, MCG, or InterQual.
- Strong analytic, interpretive, verbal, and written communication skills.
- Ability to work business hours in the EST zone with occasional holiday/weekend coverage requirements.
- Capacity to provide dedicated home workspace free from interruptions for PHI protection.
Responsibilities
- Determine authorization for requested services, levels of care, or sites of service based on clinical experience and professional judgment.
- Ensure determinations align with regulatory frameworks, national clinical guidelines, and state and CMS policies.
- Apply Medicaid requirements to operationalize knowledge in daily work within an assigned cluster.
- Perform computer-based reviews of clinical scenarios, including record analysis and decision communication to internal associates.
- Conduct peer-to-peer telephone discussions with external physicians to discuss clinical determinations.
- Engage with external physicians, facilities, and community organizations to support regional market priorities.
- Participate in care management activities and support value-based care and population health initiatives.
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