Become a part of our caring community and help us put health first
Humana Healthy in Virginia is in search of a Behavioral Health Medical Director who will oversee our behavioral health (BH) clinical program for Medicaid members in Virginia. They will collaborate closely with the Associate VP, Clinical Services, the Director, BH & Addictions and Recovery Treatment Services (ARTS), and the Chief Medical Officer (CMO) to integrate the day-to-day administration and strategic management of behavioral and physical health services, including Care Management (CM), Utilization Management (UM), Quality Improvement, and value-based payment programs. The Behavioral Health Director will be based in Virginia and will also lead the development of new products and services in Humana's Medicaid BH delivery model.
Want more jobs like this?
Get Healthcare jobs that are Remote delivered to your inbox every week.
- Leads clinical and quality management components of Humana's BH services.
- Oversees, monitors, and assists with the management of psychopharmacology pharmacy benefits manager (PBM) activities, including the establishment of prior authorization, clinical appropriateness of use, and step therapy requirements for the use of stimulants and antipsychotics for all Members; consultations and clinical guidance for contracted primary care Providers (PCPs) treating behavioral health-related concerns not requiring referral to behavioral health specialists.
- Develops comprehensive care programs for the management of youth and adult behavioral health concerns typically treated by PCPs, such as ADHD and depression.
- Develops targeted education and training for contracted PCPs to screen for mental health and substance use disorders (SUD) using evidence-based tools (e.g., AUDIT-C, PHQ-9 and GAD-7), performs diagnostic assessments, provide counseling and prescribes pharmacotherapy when indicated, and builds collaborative care models in their practices.
- Coordinates with the Medical Director to integrate the administration and management of behavioral and physical health services.
- Oversees, monitors, and assists with effective implementation of the Quality Management (QM) program; and works closely with the Care Management (CM), ARTS, Utilization Management (UM) of services and associated appeals related to children and youth and adults with mental illness and/or SUD.
- Leads BH policy development in Virginia, driving implementation, oversight, and accountability for both Humana internal and external stakeholders including but not limited to the Department of Virginia Medical Assistance (DMAS), Department of Behavioral Health and Developmental Services (DBHDS) and the Virginia Department of Health (VDH).
- Adheres to and complies with federal and Commonwealth laws and programmatic requirements.
- Collaborates with Provider relations personnel to ensure high-quality and appropriate care delivered through the BH Provider network.
- Establishes and maintains relationships with Providers, advocates, and other key Virginia stakeholders by maintaining open and ongoing communications; represents Humana at public forums and engagement opportunities.
- Maintains compliance with BH-related Contract requirements and attends oversight committee meetings to ensure appropriate procedures are adhered to within Humana and within care delivery.
- Collaborates closely with corporate and local Population Health teams in developing programs and strategies to address BH needs at a population health level.
Use your skills to make an impact
Required Qualifications
- Physician with a current, unencumbered Virginia-license board-certified in psychiatry.
- Must reside in the Commonwealth of Virginia or willing to relocate to the Commonwealth of Virginia by contract go-live date.
- Minimum five (5) years or more clinical experience working in behavioral health.
- Knowledge of the managed care industry.
- Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, CM, UM, discharge planning and/or home health or rehabilitation.
- This role is a part of Humana's Driver Safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
Preferred Qualifications
- Familiarity with Virginia-based BH organizations.
- Medicaid Managed Care clinical or behavioral health leadership experience.
Additional Information
- Workstyle: Hybrid Home - Associates Home office environment is their primary work location where the majority of their work week will be spent, but they will use Humana office space occasionally for collaboration and other face-to-face needs. The Humana Healthy Horizons Virginia office is in Glen Allen, Virginia.
- Typical Workdays/Hours: Monday - Friday; 8:00am - 5:00pm EST (some flexibility)
- Travel: Up to 20% within the state of Virginia.
Work at Home Criteria
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
#physiciancareers
Scheduled Weekly Hours
40
Pay 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.
$219,400 - $301,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
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.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.