Behavioral Health Medical Director

Humana Inc.

Job Overview

Location

Remote Louisiana

Job Type

Full-time

Full Job Description

📋 Description

• The Behavioral Health Medical Director at Humana Inc. plays a critical role in shaping behavioral health care strategy and operations, ensuring high-quality, cost-effective care delivery aligned with regulatory standards and organizational goals. This role directly impacts member outcomes by applying clinical expertise to utilization management decisions, supporting Humana’s Bold Goal mission to improve community health.
• Day-to-day responsibilities include reviewing and authorizing behavioral health services based on clinical necessity, level of care, and site of service; developing and refining utilization management procedures, productivity targets, and care delivery models; analyzing utilization patterns and demographic data to inform pricing and operational guidelines; ensuring compliance with Medicare, Medicaid, and CMS regulations; collaborating with external physicians, facilities, and community organizations to support regional market priorities and value-based care initiatives; participating in quality management, case management, and discharge planning teams; and contributing to organizational committees or project teams as needed.
• The Behavioral Health Medical Director operates within Humana’s Corporate Medical Affairs team, reporting to the Lead Corporate Medical Director, and works alongside a diverse group of clinical and operational experts focused on improving health outcomes for Medicare, Medicaid, and commercial populations. The team emphasizes collaboration, innovation, and adherence to national clinical guidelines such as MCG® and InterQual in all decision-making processes.
• In this role, the individual will deepen their expertise in managed care operations, gain hands-on experience with federal healthcare programs (Medicare, Medicaid, Medicare Advantage), and develop skills in translating clinical knowledge into operational strategies that balance quality of care with financial accountability. They will also enhance their ability to work cross-functionally with care managers, data analysts, and population health teams to address social determinants of health and drive value-based care models.

🎯 Requirements

• MD or DO degree from an accredited medical school
• 5+ years of direct clinical patient care experience post-residency or fellowship, preferably including inpatient experience and/or exposure to Medicare or Medicaid populations
• Active board certification by the American Board of Psychiatry and Neurology (ABPN)
• Current, unrestricted medical license in at least one U.S. jurisdiction, with willingness to obtain additional licenses if required
• No current sanctions from federal or state governmental agencies and ability to pass Humana’s credentialing process
• Excellent verbal and written communication skills
• Demonstrated analytic and interpretation skills, with prior experience in quality management, utilization management, case management, discharge planning, or post-acute services such as inpatient rehabilitation

🏖️ Benefits

• Competitive annual base pay ranging from $223,800 to $313,100, plus eligibility for performance-based bonus incentives
• Comprehensive benefits package including medical, dental, and vision insurance; 401(k) retirement savings plan; paid time off; parental and caregiver leave; short- and long-term disability; and life insurance
• Remote work flexibility with the ability to reside anywhere in the continental U.S., required to work EST zone hours (8am–5pm); Humana provides telephone equipment and supports home office setup with internet speed recommendations (minimum 25 Mbps download, 10 Mbps upload)
• Opportunities for occasional travel to Humana offices for training or meetings; exposure to national clinical guidelines (MCG®, InterQual), CMS policies, and value-based care initiatives
• Support for professional growth through access to internal teaching conferences, clinical reference materials, and collaboration with experts in population health, social determinants of health, and care management

Skills & Technologies

Remote

$223k-313k

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Humana Inc.

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About Humana Inc.

Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.

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