About this role
Role Overview
- Responsible for behavioral health care strategies and/or operations
- Make determinations for requested services, levels of care, or sites of service authorization
- Learn Medicaid requirements and operationalize this knowledge daily
- Conduct computer-based reviews of complex clinical scenarios and clinical records
- Communicate decisions to internal associates and participate in care management as needed
- Conduct discussions with external physicians to gather clinical information or discuss determinations
- Support Humana values working collaboratively on a team throughout all activities
Requirements
- Doctor of Medicine or Doctor of Osteopathy
- Board-certified in ABMS or ABPN recognized specialty of Psychiatry
- A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required
- At least five years of experience post-training providing clinical services
- Experience in utilization management review and case management in a health plan setting
- No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
Benefits
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance and many other opportunities