Description
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.
Responsibilities
Essential Functions and Responsibilities
- Lead major clinical and quality management components of Humana’s BH services
- 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 the age of eighteen (18); consultations and clinical guidance for contracted Primary Care Providers (PCPs) treating behavioral health-related concerns not requiring referral to behavioral health specialists;
- Develop comprehensive care programs for the management of youth and adult behavioral health concerns typically treated by PCPs, such as ADHD and depression;
- Develop targeted education and training for contracted PCPs to screen for mental health and substance use disorders 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;
- Coordinate with the Medical Director to integrate the administration and management of behavioral and physical health services;
- Oversee, monitor and assist with effective implementation of the Quality Management (QM) program; and work closely with the Utilization Management (UM) of services and associated Appeals related to children and youth and adults with mental illness and/or substance use disorders (SUD)
- 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
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
Additional Information
Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.
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