Role: Behavioral Health Medical Director (Psychiatrist) Location: Work at Home OR in Office location - South Florida/North Florida Clinical: Make a difference in people’s lives Our dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares. Assignment Capsule Humana is seeking a Behavioral Health Medical Director that will collaborate with other health care givers in reviewing actual and proposed medical care services against established CMS, DOI, Humana and other nationally recognized and accepted guidelines. * Assist in the development and implementation of behavioral health policies as they relate to health services utilization. * Directs the efforts of the utilization review, case management, and precertification function to accomplish objectives within policy and budget. * Performs daily behavioral health reviews. * Work collaboratively with the Regional Medical Director to build credibility by actively creating linkages with the provider community; working with community Behavioral Health leaders to develop more cost-effective means for care management; regularly communicate with providers regarding plan goals, and getting buy-in to support successful policy and program implementation. * Participate with the quality management function in the identification and analysis of medical information in order to develop interventions to improve quality of care and outcomes for our members. Key Competencies * Interpersonal Effectiveness: Understands oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships. * Accountability: Meets established expectations and takes responsibility for achieving results; encourages others to do the same. * Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first. * Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. Role Essentials * Board Certified Psychiatrist * MD/DO with active unrestricted license and the willingness to obtain additional licenses as requested * Excellent communication skills, with 5 years of established behavioral health clinical experience * Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products * Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, and discharge planning Role Desirables * Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc * Previous Medicare, Medicaid, and/or Commercial utilization review experience * Bilingual Spanish **Title:** *Behavioral Health Medical Director (Psychiatrist) - Work At Home Florida* **Location:** *FL-Tampa* **Other Locations:** *US-FL-Miami* **Requisition ID:** *191118* Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.
Posted date: April 22, 2018