Remote Behavioral Health Medical Director, Medicaid

Humana Inc; Illinois; Hybrid; USD 224,000 - 313,000; Full time

Job summary

Humana Inc. is seeking a Behavioral Health Medical Director to lead Medicaid behavioral health utilization management in Illinois. The role entails reviewing complex requests, applying clinical criteria and Medicaid policies, and making timely medical-necessity determinations.

This remote position reports to the Lead Behavioral Health Medical Director and may support other Medicaid markets. Responsibilities include peer-to-peer consultations, appeals, provider disputes, quality reviews, state

Qualifications

• MD or DO degree with board certification in psychiatry (ABPN) or equivalent.
• Active, unrestricted Illinois medical license at hire and ability to obtain others as needed.
• At least five years of post-training clinical experience.
• Experience in utilization management / medical-necessity review.
• Excellent written and verbal communication with strong clinical analysis.
• Eligibility to participate in federal and state healthcare programs.

Responsibilities

• Provide clinical leadership for Medicaid behavioral health utilization management.
• Review complex behavioral health requests and render timely, defensible determinations.
• Conduct peer-to-peer consultations, appeals, provider disputes, and regulatory activities.
• Collaborate with providers and internal partners; manage high-volume, time-sensitive work.
• Support coverage during planned/unplanned absences and on-call rotations.
• Maintain confidentiality and comply with privacy, security, credentialing requirements.

Skills

Clinical leadership

Peer-to-peer consultations

Remote work experience

Strong communication

Education

MD/DO

Board certified in Psychiatry (ABPN)

Job description

Humana Inc. is seeking a Behavioral Health Medical Director to lead Medicaid behavioral health utilization management in Illinois. The role entails reviewing complex requests, applying clinical criteria and Medicaid policies, and making timely medical-necessity determinations.

This remote position reports to the Lead Behavioral Health Medical Director and may support other Medicaid markets. Responsibilities include peer-to-peer consultations, appeals, provider disputes, quality reviews, state