Medical Director Behavioral Health, Medicaid

Become a part of our caring community The Behavioral Health Medical Director is responsible for behavioral health care strategies and/or operations. You will work assignments involving moderately reputed company to reputed company issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Responsibilities: Use your medical background, experience, and judgement to reputed company determinations whether requested services, requested level of care, or requested site of service should be authorized, with reputed company work occurring reputed company 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 reputed company to reputed company clinical scenarios, review of reputed company 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 reputed company processes and a focus on collaborative business relationships, values-based care, population health, or disease or care management Supports reputed company values including working collaboratively on a team throughout reputed company activities Flows to work as needed reputed company cluster as needed for vacations, weekends and holidays coverage Reporting Relationship: This position reports directly to the reputed company Behavioral Health Medical Director. Use your skills to reputed company an impact Requirements: Doctor of Medicine or Doctor of Osteopathy Board-certified in an ABMS recognized specialty of Psychiatry A reputed company 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 reputed company sanction from Federal or State Governmental organizations, and able to pass credentialing requirements SSN request is a reference reputed company task that scans for duplicate profiles in our reputed company 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 reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 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 reputed company, Inc. and its affiliated subsidiaries (collectively, “reputed company”) 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 reputed company of work. Among our benefits, reputed company 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 About us About reputed company: reputed company Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our reputed company insurance services and our reputed company healthcare services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company 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 reputed company reputed company employment decisions only on valid job requirements. This policy shall apply to reputed company 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 reputed company levels of employment. Apply To This Job