Medical Director - Behavioral Health - Tricare

Profile

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 Government Business's (HGB) Behavioral Health Medical Director will provide clinical oversight to Behavioral Health (BH) administrative and clinical programs for TRICARE beneficiaries. They will collaborate closely with the Executive Committee members to integrate the day-to-day administration and strategic management of behavioral and physical health services, including utilization management (UM), Case Management (CM), Disease Management (DM), population health management, contract compliance, quality improvement, and pilot/value-based payment programs. The BH Medical Director will also provide leadership in the development of new products and services in HGB the Integrated Care Delivery Model.

Essential Functions and Responsibilities


Lead clinical and quality management components of HGB's Integrated Care Delivery Model
Provide clinical case management consultations and clinical guidance for Medical Operations and Market 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 to Behavioral Health, Substance Use Disorder (SUD), and integrated coordination with medical and surgical cases in populations ranging from birth to 64 years of age. Develop and contribute to Focused Reviews on various topics relevant to the Defense Health Agency (DHA) customer.

Develop targeted education and training for HGB providers on behavioral health and Substance Use Disorder conditions, clinical practice guidelines, and outcome measure usage.
Contribute to value-based care initiatives and business development to maintain competitive edge in TRICARE Health Care Delivery.
Lead BH HGB policy development to ensure compliance with contract and TRICARE policy and drive 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 Market 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
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
Possess an American Board of Medical Specialty certification is psychiatry


Preferred Qualifications


Experience in managing and leading military health care operations care is desirable
Prior military service
Previous administrative experience with military or managed care organization or health administration organization (i.e. private, county, state, or federal)
Possess analytic and interpretation skills with prior experience leading teams focusing on quality management, UM, CM, DM, and/or special projects.


Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:


At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information


#LI-Remote

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

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