Medical Director Behavioral Health, Medicaid
Humana
Swindon, England, United Kingdom
Full-Time
$223,800
RemoteDirector
Responsibilities:
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, which may include national clinical guidelines, state policies, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources
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, 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, values-based care, population health, or disease or care management
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
Reporting Relationship:
This position reports directly to the Lead Behavioral Health Medical Director.
Requirements:
Doctor of Medicine or Doctor of Osteopathy
Board-certified in an ABMS recognized specialty of Psychiatry
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
No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
SSN request is a reference check task that scans for duplicate profiles in our Workday ATS that will be requested at the offer stage
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
Has licensure through the Interstate Medical Licensure Compact
Has a Louisiana medical license
Has experience with application of MCG and ASAM criteria
License/Credential Requirement
Physician with an active, unencumbered license in at least one of the states that are part of the specific cluster (Louisiana, Oklahoma, Indiana, Ohio, Florida, Virginia, Kentucky).
Location: This role is based virtually in one of the states of the specific cluster.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.Application Deadline: 12-20-2026
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.