Join our compassionate team and prioritize health like never before! We are seeking a dedicated Director of Behavioral Health Services who will play a crucial role in shaping our behavioral health care strategies and operations. This position encompasses complex issues that require thorough analysis and evaluation of various factors to ensure optimal care decisions. Key Responsibilities: Utilize your medical expertise and judgment to assess and authorize requests for services, levels of care, or sites of service, ensuring compliance with regulations and guiding principles from diverse clinical resources. Acquire knowledge of Medicaid requirements and effectively integrate this understanding into daily operational tasks within your assigned area. Conduct thorough reviews of clinical scenarios through a computer-based system, assess submitted clinical records, prioritize daily tasks, communicate decisions internally, and potentially engage in care management processes. Engage in discussions with external physicians to gather additional clinical insights or resolve issues through peer-to-peer discussions, employing conflict resolution skills when necessary. Collaborate with external partners, such as physician groups and community organizations, to advance regional market objectives, focusing on value-based care and population health strategies. Emphasize Humana's values of teamwork and cooperation across all activities. Be flexible to cover team responsibilities as needed for vacations, weekends, or holidays. Reporting Structure: This position reports directly to the Lead Behavioral Health Medical Director. Use your expertise to make a difference! Requirements: • Doctor of Medicine (MD) or Doctor of Osteopathy (DO) degree • Board-certification in an ABMS or ABPN recognized specialty in Psychiatry • Current, unencumbered medical license in at least one jurisdiction, with a willingness to obtain additional licenses as needed • Minimum of five years of post-training clinical experience • Experience in utilization management review and case management within a health plan environment • No current sanctions from governmental bodies, able to meet credentialing requirements. Preferred Qualifications: • Experience engaging with Medicaid enrollees and providers in clinical or administrative capacities • Familiarity with accreditation processes, such as NCQA • Experience with CGX and MHK systems • Licensure through the Interstate Medical Licensure Compact • Possession of a Virginia medical license • Knowledge of MCG and ASAM criteria applications Licensure Requirement: Possess an active, unencumbered medical license in one of the states within our assigned cluster (Louisiana, Oklahoma, Indiana, Ohio, Florida, Virginia, Kentucky). Location: This role is offered as a remote position, with a preference for candidates in the specific cluster states. Travel: Occasional travel to Humana's offices for training or meetings may be required. Weekly Hours: 40 Compensation: The compensation range for this role is $223,800 - $313,100 annually, reflective of a good faith estimate at the time of posting. Actual pay may vary based on geographic location, individual experience, and skills. This position is also eligible for performance-based bonus incentives. Benefits Overview: Humana offers robust benefits aimed at supporting the well-being of our associates and their families. Our benefits include medical, dental, and vision plans, a 401(k) retirement savings plan, generous time off policies, short- and long-term disability insurance, life insurance, and more. Application Deadline: 04-11-2026 About Us: Humana Inc. is committed to putting health first for our employees, customers, and the communities we serve. Through our insurance and healthcare services, we work to facilitate access to high-quality care for millions, enhancing the lives of individuals, families, and service members. Equal Opportunity Employer: Humana is dedicated to creating a diverse workforce and does not discriminate against any employee or applicant based on race, color, religion, gender, sexual orientation, gender identity, national origin, age, marital status, disability, or veteran status. We are committed to providing opportunities for all individuals in compliance with applicable laws.
