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Humana Behavioral Health Medical Director - Ohio in Cincinnati, Ohio


Humana's Medicaid Behavioral Health Medical Director will oversee our behavioral health (BH) clinical program for Medicaid plan members. They will collaborate closely with the Chief Medical Officer (CMO) and the Behavioral Health Administrative Director 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 Ohio and will also lead the development of new products and services in Humana's Medicaid BH delivery model.


Job Title: Behavioral Health Medical Director- Ohio

Location: Must live in Ohio

Essential Functions and Responsibilities

  • Lead major clinical and quality management components of Humana's BH services

  • Provide clinical case management consultations and clinical guidance for contracted primary care physicians (PCPs) treating BH-related concerns not requiring referral to BH specialists

  • Develop comprehensive care programs for the management of youth and adult BH concerns typically treated by PCPs (such as ADHD and depression)

  • Oversee, monitor and assist with effective implementation of the Quality Management (QM) program; accountable for overall continuous improvement of BH services and programs

  • 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 age 18

  • Work closely with the UM of services and associated appeals related to children and youth and adults with mental illness and/or substance use disorders (SUD)

  • Develop targeted education and training for Humana PCPs to screen for mental health and SUD using evidence-based tools (e.g. AUDIT-C, PHQ-9, CANS and GAD-7), perform diagnostic assessments, provide counseling and prescribe pharmacotherapy when indicated, and build collaborative care models in their practices

  • Lead BH policy development in the state, 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 state agencies, other health plans and OhioRISE health plan for health plan members who qualify for OhioRISE coverage and services

  • Collaborate with provider relations personnel to ensure high-quality and appropriate care delivered through the BH provider network as well as consultation on BH network development

  • Establish and maintain relationships with providers, advocates, and other key state 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

  • Participate in regulatory/accreditation reviews

  • Play a lead role in monitoring the overall safety of members with a behavioral health diagnosis, with a special focus on safe prescribing of psychotropic medications as well as all controlled substances

  • Required Qualifications * Physician with a current, unencumbered Ohio state license as a physician* Board-certified in psychiatry/Addiction Medicine/Child Behavioral Health* At least three (3) years of training in a medical specialty* Experience with children's behavioral health * Experience with ASAM levels of care * Experience developing and Implementing evidence-based clinical policy

Preferred Qualifications

  • Five (5) years or more clinical experience working in behavioral health

  • Familiarity with whole person care and population health concepts

  • Experience working with multi-system youth

  • Familiarity with state-based behavioral health organizations

  • Medicaid Managed Care clinical or behavioral health leadership experience

  • Familiarity and experience with public speaking and presentations

  • 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

Scheduled Weekly Hours