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    Behavioral Health Medical Director - Boise, United States - Idaho State Job Bank

    Idaho State Job Bank
    Idaho State Job Bank Boise, United States

    4 weeks ago

    Idaho State Job Bank background
    Description
    Behavioral Health Medical Director
    • Southwest Medicaid at Humana in Boise, Idaho, United States Job Description Become a part of our caring community and help us put health first The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations.
    The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.


    Position Responsibilities:
    Uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, or requested site of service should be authorized, with all work occurring within a context of regulatory compliance and assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources Learns Medicaid requirements and understands how to operationalize this knowledge in their daily work in their assigned cluster (Southwest cluster currently serves Louisiana and Oklahoma)

    Work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management, with clinical scenarios arising from outpatient or inpatient environments Conducts discussions with external physicians by phone to gather additional clinical information or discuss determinations through the peer-to-peer process, and in some instances, these may require conflict resolution skills May speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes and a focus on collaborative business relationships, value-based care, population health, or disease or care management Supports Humana values and our enterprise social needs team mission throughout all activities Flows to work as needed within cluster as needed for vacations, weekends and holidays coverage Reporting Relationship:
    This position reports directly to the Cluster Lead Medical Director.

    Use your skills to make an impact REQUIREMENTS:
    Doctor of Medicine or Doctor of Osteopathy Board-certified in ABMS or ABPN recognized specialty A current and unrestricted license in at least one jurisdiction and willing to obtain additional lic To view full details and how to apply, please login or create a Job Seeker account
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