Medical Director - BH/MH

📋 Description

• • The Behavioral Health Medical Director is responsible for behavioral health care strategies and/or operations, working on moderately complex to complex issues requiring in-depth evaluation of variable factors.
• • Day-to-day responsibilities include using medical background and judgment to determine authorization of services, level of care, or site of service in compliance with regulations; reviewing clinical records; communicating decisions to internal associates; conducting peer-to-peer discussions with external physicians; and supporting regional market priorities through collaboration with contracted providers and community groups.
• • The role is part of Humana Inc., a leading U.S. healthcare company dedicated to improving health outcomes for people with Medicare and Medicaid, families, individuals, military personnel, and communities through its insurance and CenterWell healthcare services.
• • In this role, the individual can deepen expertise in utilization management, Medicaid operations, and value-based care while contributing to population health initiatives and gaining experience in regulatory compliance, clinical guidelines, and interdisciplinary collaboration within a national healthcare organization.