Behavioral Health Medical Director - Louisiana Medicaid

Employment Type

: Full-Time

Industry

: Healthcare - Allied Health



Description

The Medical Director relies on medical background and reviews health claims. The 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.

Responsibilities

Humana’s Louisiana Medicaid BH Medical Director will oversee our behavioral health (BH) clinical program for Louisiana Medicaid plan members. They will collaborate closely with the Chief Medical Officer (CMO) to integrate the day-to-day administration and strategic management of behavioral and physical health services, including utilization management (UM), quality improvement, and value-based payment programs. The BH Medical Director will be based in Louisiana and will also lead the development of new products and services in Humana’s Medicaid BH delivery model.

Essential Functions and Responsibilities

  • Lead major clinical and quality management components of Humana’s BH services
  • Provide clinical case management consultations and clinical guidance for contracted primary care physicians (PCPs) treating BH-related concerns not requiring referral to BH specialists
  • Develop comprehensive care programs for the management of youth and adult BH concerns typically treated by PCPs (such as ADHD and depression)
  • Oversee, monitor and assist with effective implementation of the Quality Management (QM) program; accountable for overall continuous improvement of BH services and programs
  • Oversee, monitor, and assist with the management of psychopharmacology pharmacy benefits manager (PBM) activities, including the establishment of prior authorization, clinical appropriateness of use, and step therapy requirements for the use of stimulants and antipsychotics for all enrollees under age 18
  • Work closely with the UM of services and associated appeals related to children and youth and adults with mental illness and/or substance use disorders (SUD)
  • Develop targeted education and training for Humana PCPs to screen for mental health and SUD using evidence-based tools (e.g. AUDIT-C, PHQ-9, and GAD-7), perform diagnostic assessments, provide counseling and prescribe pharmacotherapy when indicated, and build collaborative care models in their practices
  • Lead BH policy development in Louisiana, driving implementation, oversight, and accountability for both Humana internal and external stakeholders
  • Adhere to and comply with federal and state laws and programmatic requirements
  • Collaborate with provider relations personnel to ensure high-quality and appropriate care delivered through the BH provider network
  • Establish and maintain relationships with providers, advocates, and other key Louisiana stakeholders by maintaining open and ongoing communications; represent Humana 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
  • Share responsibility for the management of the BH services delivery system with the BH Coordinator and Addictionologist/Addiction Services Manager
  • Serve as co-chairperson of Humana’s Louisiana Quality Improvement Committee
  • Required Education, Certification, & Experience Qualifications

  • Physician with a current, unencumbered Louisiana-license as a physician
  • Board-certified in psychiatry
  • At least three (3) years of training in a medical specialty
  • Knowledge of the managed care industry
  • Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, UM, discharge planning and/or home health or rehab
  • Preferred Experience Qualifications

  • Five (5) years or more clinical experience working in BH
  • Familiarity with Louisiana-based BH organizations
  • Medicaid Managed Care clinical or behavioral health leadership experience
  • #PhysicianCareers

    Scheduled Weekly Hours

    40

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