Behavioral Health Lead Medical Director

Profile

Description

The Lead Behavioral Health Medical Director oversees the work of 2 Medical Directors who conduct clinical case reviews of the care received by members in an assigned market, member population, or condition type and may also spend a portion of their time doing case reviews themselves. The Lead Behavioral Health Medical Director may also lead specific functional area in addition to leading a team of Medical Directors.

Responsibilities

The Lead Medical Director for the Humana Clinical Operations Behavioral Division is looking for a candidate with experience in the insurance industry around behavioral and physical integration, care modeling, best practice with behavioral health membership challenged with social determinants and obtaining timely healthcare.

The Lead Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates.

The Lead Behavioral Health Medical Director will be responsible for


Managing utilization review processes performed by Behavioral Health Reviewing Medical Directors.
Managing the vendor(s) implementing initial reviews for behavioral cases as they pertain to utilization management.
Identifying medical management operational improvements, including those within the medical director area
Developing and implementing BH strategy/impact trend/analyze spend
Developing collaborative relationships with Team and key partners within the Medicare Line of Business.
Supporting G&A MD Team engagement, operational, and other meetings
Managing KPIs for UM team - DPT ALOS
BH Director for Interrater Reliability exam, reviewer and Educator, IRR Focus Director
Performance plan reviews
HUM Home - IMBH Rounds and Executive Inquiries
HUM Commercial ICM Rounds ( BH and PH )
HUM Consult Team
Interfacing with CMO/ECOM/Strategy/HCO/SCS/SCO for presentations as it relates to BH strategy/trend/spend,
Interfacing with Pharmacy/Product/Quality/Policy/Procedure/Legal/Compliance/Contracting/Operations/MHPAEA


Required Qualifications


Bachelor's Degree
MD or DO degree
Board Certified Psychiatrist
Current and ongoing board certification in an approved ABMS Medical Specialty
A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment
5 years of direct clinical patient care experience post residency or fellowship
4 years of management experience
No current sanction from Federal or State Governmental organizations
The ability to pass credentialing requirements
Excellent verbal and written communication skills with analytic and interpretative skills
Knowledge and experience with national guidelines such as NCD/LCD, MCG® or InterQual and ASAM


Preferred Qualifications


Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
Internal Medicine, Family Practice, Geriatrics, Hospitalist clinical specialists
Previous Medicare, Medicaid, and/or Commercial experience
Experience in an inpatient behavioral health environment and/or related to care of a Medicare type population (disabled or >65 years of age)
Ability to function in a dynamic fast paced environment
Commitment to a culture of innovation
Passionate about contributing to an organization's focus on consistency in outcomes, consumer experiences and a highly engaged team culture


Additional Information

Must be willing to work until 5:30pm CST

Must be willing to travel 25% for leadership meetings

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire.

Scheduled Weekly Hours

40

Company info

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