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Humana

Louisville, Kentucky-based Humana is a leading healthcare company that offers a variety of health, wellness, and insurance products and services designed to off

Medical Director

Location

United States

Posted

98 days ago

Salary

$223.8K - $313.1K / year

Seniority

Lead

Postgraduate Degree10 yrs expEnglish

Job Description

Medical Director

Humana

• Review clinical cases and determine medical necessity of services for Medicare and Medicaid members • Ensure compliance with review policies, procedures, and regulatory standards • Apply clinical guidelines, CMS policies, and Medicare/Medicare Advantage/Medicaid requirements • Identify opportunities for medical management operational improvements • Participate in call rotations, including weekend coverage and after-hours coverage • Contribute to an engaged, collaborative team culture that supports organizational excellence • Deliver exceptional consumer experiences • Support Home Solutions and other activities as assigned by the OneHome leadership

Job Requirements

  • MD or DO degree
  • Current, active and ongoing board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialties (AOABPS). National Board of Physicians & Surgeons (NBPAS) certification is not accepted
  • Current and unrestricted state license in at least one state and willing to obtain other medical licenses, as required, for various states in region of assignment
  • No sanctions from Federal or State Governmental organizations
  • 10 years of direct clinical patient care experience post residency or fellowship
  • The ability to pass credentialing requirements
  • Intermediate to advanced skills utilizing Microsoft Office and Internet navigation
  • Strong verbal and written communication skills, with the ability to analyze information and interpret data clearly and accurately
  • Adaptable and willing to learn new technologies to enhance workflow efficiency
  • Participate in educational activities by attending required conferences and creating content to present for individual subject matter contribution

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
  • many other opportunities

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