Join Our Compassionate Team
The Behavioral Health Medical Director plays a pivotal role in shaping and overseeing behavioral health care strategies and operations. This position involves addressing complex issues that require thorough analysis and evaluation of diverse factors.
Make a Difference in Our Community
As a Behavioral Health Medical Director, you will leverage your medical knowledge and experience to determine the authorization of requested services, levels of care, and service sites, all while ensuring compliance with regulations. You will utilize various resources, including clinical guidelines, CMS policies, and internal training, to support your efforts.
In this role, you will gain insight into Medicare, Medicare Advantage, and Medicaid requirements, which will guide your daily activities. You will actively participate in care management, provider relations, quality assurance, audits, grievances, appeals, and policy review efforts.
The Medical Director is responsible for conducting computer-based reviews of clinical cases, evaluating clinical records, prioritizing tasks, and communicating decisions effectively with internal teams. You will also have regular discussions with external physicians to gather clinical information, often requiring skills in conflict resolution.
Your expertise will be vital when collaborating with contracted external physicians and community groups to further regional priorities, emphasizing collaborative relationships, value-based care, quality metrics, population health, and innovative delivery models. You will also develop processes and productivity targets, maintaining operational efficiency and ensuring quality care and financial targets.
Make Your Impact
Required Qualifications
MD or DO degree
Board Certification in Psychiatry is mandatory
5+ years of direct clinical experience post-residency, ideally in an inpatient or Medicare/Medicaid context
Current, unrestricted medical license in at least one jurisdiction
No current sanctions from Federal or State entities; ability to meet credentialing standards
Exceptional verbal and written communication skills
Demonstrated analytical skills and experience with quality management, utilization management, and case management
Fully remote schedule from 9am-6pm EST, Monday to Friday, with weekend availability as needed
Preferred Qualifications
Understanding of managed care, including Medicare Advantage and Managed Medicaid
Experience in utilization management within a medical review setting
Familiarity with guidelines like MCG®, ASAM, or InterQual
Advanced degree such as MBA, MHA, or MPH, with knowledge of Public Health and population health analytics
Experience collaborating with case or care managers on complex cases
A passion for learning, adaptability, and a willingness to innovate
Additional Information
This role typically reports to an Associate Vice President of Health Services or Corporate Medical Director, depending on the size of the region or business line.
Work from Home Guidelines
Minimum internet requirements: 25 Mbps download speed and 10 Mbps upload speed
Associates residing in California, Illinois, Montana, or South Dakota will receive bi-weekly support for internet expenses
Humana will provide necessary phone equipment for remote work
Work from a dedicated space free from interruptions to protect member information
Travel to Humana's offices may be required for training or meetings.
Scheduled Weekly Hours: 40
Compensation Range: $223,800 - $313,100 per year, based on experience, skills, and location. This position is eligible for a performance-based bonus incentive.
Benefits Overview: Humana offers comprehensive benefits to support overall well-being, including medical, dental, and vision coverage, 401(k) plans, paid time off, disability insurance, life insurance, and more.
Application Deadline: 09-12-2026
About Humana
Humana Inc. is a leading healthcare provider dedicated to improving health outcomes for those we serve, including individuals with Medicare and Medicaid, families, and communities. Learn more about our services at Humana.com and CenterWell.com.
Equal Opportunity Employer
Humana is committed to an inclusive work environment and does not discriminate on any basis. We take affirmative action to employ individuals with disabilities and protected veterans.