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Behavioral Health Medical Director - Humana Government Busin

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Job Details
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Company Name
Physical Address

Chicago, IL 60684
Job Description


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

Required Qualifications

+ 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

Preferred Qualifications

• 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


About Us

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.

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