Humana Behavioral Health Medical Director – Humana Government Business in Boston, Massachusetts
The Medical Director is a leadership position that leverages medical expertise, understanding of the TRICARE business, and managed care to support and lead on both clinical programs as well as strategic initiatives and new business matters. The Medical Director works on assignments that involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Job Title: Behavioral Health Medical Director – Humana Government Business
Location: Work at Home - US
Humana Government Business’s (HGB) Behavioral Health Medical Director will oversee our behavioral health (BH) clinical program for TRICARE beneficiaries. They will collaborate closely with the Chief Medical Officer (CMO) and core business leaders to integrate the day-to-day administration and strategic management of behavioral and physical health services, including utilization management (UM), case management, disease management, population health management, contract compliance, quality improvement, and value-based payment programs. The BH Medical Director will also lead the development of new products and services in the HGB Integrated Care Delivery Model.
Essential Functions and Responsibilities
•Lead major clinical and quality management components of HGB’s Integrated Care Delivery Model.
•Provide clinical case management consultations and clinical guidance for Medical Operations and the Autism Care Demonstration operations.
•Develop comprehensive care programs for various segments of the TRICARE beneficiary population (such as RTC care, PTSD, Substance Use Disorders, Autistic Spectrum Disorder, and chronic pain).
•Oversee, monitor and assist with effective implementation of the Quality Management (QM) program; accountable for overall continuous improvement of BH services and programs within the Integrated Care Delivery Model.
•Work closely with the UM, CM, and DM of services, as well as the Pharmacy Management Program (PMP) of services associated with Behavioral Health, Substance Use Disorder (SUD), and integrated coordination with medical and surgical cases.
•Develop and contribute to Focused Reviews on various topics relevant to the Defense Health Agency (DHA) customer.
•Contribute to value-based care initiatives and business development to maintain competitive edge in TRICARE Health Care Delivery. Lead BH HGB policy development, implementation, oversight, and accountability for both HGB internal and external stakeholders.
•Adhere to and comply with DHA, federal and state laws and programmatic requirements.
•Collaborate with Field Operations personnel to ensure high quality and appropriate care and education delivered through the BH provider network.
•Establish and maintain relationships with providers, advocates, and other key state stakeholders by maintaining open and ongoing communications; represent HGB at public forums and engagement opportunities.
•Maintain compliance with BH-related contract requirements and attend oversight committee meetings to ensure appropriate procedures are adhered to within Humana and within care delivery.
•Collaborate closely with corporate and local population health teams in developing programs and strategies to address BH needs at a population health level
Executive presence amongst internal and external leaders, as this individual is representing Humana Military’s brand amongst the military community
Five (5) years or more clinical experience working in behavioral health & excellent communication skills
Willingness and desire to work with Special Needs medicine
Willingness to develop data analytic knowledge, skills, and abilities
Ability to direct or assign work without the guidance of management
Embraces thriving in an ever evolving business environment
Physician with a current, unencumbered US medical license
Ability to pass an Equip security clearance background check
Board-certified in psychiatry
• Experience in managing and leading military health care operations care is desirable
•Knowledge of the managed care industry
•Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, UM, CM, and/or DM
Scheduled Weekly Hours
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
Equal Opportunity Employer
It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.
If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact firstname.lastname@example.org for assistance.
Humana Safety and Security
Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact email@example.com to validate the request.
If you are a California resident and would like to review our California Consumer Privacy Act (CCPA) Policy click here:
- Humana Jobs