Medical Director, Medicaid

Humana

. Provide clinical leadership for Medicaid behavioral health utilization management .

Posted 10/2/2026full-timeRemote • Illinois • United StatesLead💰 $223,800 - $313,100 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicaid behavioral health utilization management, including clinical leadership, medical-necessity determinations, and compliance with state regulations. Possesses strong communication and analytical skills to effectively manage high-volume workloads and collaborate with providers.

Highest-signal resume keywords

Doctor Of Medicine (MD) Or Doctor Of Osteopathic Medicine (DO)Board Certified In PsychiatryUtilization Management ExperienceClinical Analysis And InterpretationPeer Review Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical-Necessity ReviewClinical Decision-MakingBehavioral Health Utilization ManagementEvidence-Based Guidelines ApplicationRegulatory Compliance

Soft Skills

Excellent Written CommunicationExcellent Verbal CommunicationConflict Resolution AbilitiesTime Management

Tools & Technologies

Remote Communication TechnologyClinical Information Review Tools

Certifications & Qualifications

Board Certification By The American Board Of Psychiatry And NeurologyActive Illinois Medical License

Industry Keywords

Medicaid PoliciesState RegulationsPeer-To-Peer ConsultationsUtilization ReviewsPrivacy And Security Compliance

About the role

Key responsibilities & impact

Provide clinical leadership for Medicaid behavioral health utilization management
Review complex behavioral health requests and clinical records across levels of care and specialty services
Apply clinical criteria, Medicaid policies, state regulations, evidence-based national guidelines, and Medicaid requirements
Make timely, consistent, and defensible medical-necessity determinations
Conduct peer-to-peer consultations and discussions
Support utilization reviews, appeals, provider disputes, state fair hearings, audits, and regulatory activities
Collaborate with providers and internal partners
Participate in case consultations, training, and process improvement
Manage high-volume, time-sensitive work and provide coverage during absences, holidays, and on-call rotations
Maintain confidentiality and comply with privacy, security, credentialing, and organizational requirements
Report to the Lead Behavioral Health Medical Director or another designated physician leader

Requirements

What you’ll need

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)
Board certified in psychiatry by the American Board of Psychiatry and Neurology (ABPN) or another recognized certifying board
Active, unrestricted Illinois medical license at the time of hiring
Ability to obtain and maintain additional state licenses as needed for assigned Medicaid markets
At least five years of post-training clinical experience
Experience in utilization management, medical-necessity review, peer review, or comparable clinical decision-making
Excellent written and verbal communication skills
Strong clinical analysis, interpretation, and conflict-resolution abilities
Ability to independently manage a high-volume workload while meeting quality, compliance, and turnaround requirements
Experience working effectively in a remote environment and using technology to communicate, collaborate, review clinical information, and complete assigned work
Eligibility to participate in federal and state healthcare programs and ability to meet employment onboarding requirements
Reliable attendance and strict adherence to the assigned work schedule
Participation in rotating holiday and on-call coverage, as applicable
Self-provided internet service with at least 25 Mbps download and 10 Mbps upload speed
Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical, dental, and vision benefits
401(k) retirement savings plan
Paid time off
Company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Limited travel for training, meetings, conferences, or other business purposes
Fully remote work
Rotating holiday and on-call coverage, as applicable