Behavioral Health Medical Director - N. Central Medicaid - Remote US
The Behavioral Health Medical Director may develop procedures, processes, productivity targets, and new delivery models. Maintains efficient operations while ensuring attainment of quality of care and financial goals. Provides information for pricing guidelines based on utilization patterns and client demographics. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.
The Behavioral Health Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise.
The Behavioral Health Medical Directors will learn Medicare, Medicare Advantage and/or Medicaid requirements, and will understand how to operationalize this knowledge in their daily work.
The Behavioral Health Medical Director 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, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management.
Use your skills to make an impact
Required Qualifications:
- MD or DO degree
- 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare or Medicaid type population
- Current and ongoing Board certification in Psychiatry with Addiction specialty as outlined by ASAM credentials
- A current and unrestricted license in …
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Regions Countries Benefits/Perks401(k) retirement savings plan Bonus incentive plan Competitive benefits Dental Life Insurance Medical Paid parental and caregiver leave Paid Time Off Parental and Caregiver Leave Personal holidays Time off Vision Vision Benefits Volunteer time
SkillsAnalytic Analytics Behavioral health Business Care management Case Management Communication Compliance Healthcare Health Insurance InterQual Managed Care Medicaid Medicare National Guidelines Operations Population health Psychiatry Public health Quality Management Regulatory Compliance Social Determinants of Health Teams Utilization management Wellness Written communication
Tasks- Compliance
- Support regional market priorities
- Training
5+ years
EducationAdvanced degree Business Communication DO M.D.
Certifications RestrictionsRemote US
TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9