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Medical Director - Acute Rehab
Location
United States
Posted
9 days ago
Salary
$223.8K - $313.1K / year
Seniority
Lead
No structured requirement data.
Job Description
Medical Director - Acute Rehab
Humana
Role Description The Medical Director uses their medical background, experience, and judgement to determine whether to authorize requested services, requested level of care, and requested site of service. All work occurs within a context of regulatory compliance, and diverse resources assist work, including national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work specifically for DSNP. The Medical Director's work includes: - Computer-based review of moderately complex to complex clinical scenarios. - Review of all submitted clinical records. - Prioritization of daily work. - Communication of decisions to internal associates. - Discussions with external physicians by phone to gather additional clinical information or discuss determinations. - Conflict resolution skills when necessary. Qualifications - MD or DO degree. - 5+ years of direct clinical patient care experience post residency or fellowship, preferably including some experience in an inpatient environment related to acute inpatient rehabilitation. - Board Certified in an approved ABMS or AOA Medical Specialty with continued certification throughout employment. - A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s). - No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. - Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, and acute inpatient rehabilitation. - Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers. - Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid. - Physical Medicine and Rehabilitation, Internal Medicine, Family Practice, Geriatrics, or Hospitalist background. Requirements - Advanced degrees such as an MBA, MHA, MPH (preferred). - Exposure to Public Health, Population Health, analytics, and use of business metrics (preferred). - Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health (preferred). Benefits - Competitive 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 for personal wellness and smart healthcare decisions. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance. Work at Home Guidance - Self-provided internet service must meet a minimum download speed of 25 Mbps and an upload speed of 10 Mbps. - Wireless, wired cable or DSL connection is suggested; satellite, cellular and microwave connection can only be used if leadership approves it. - Associates in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for their internet expense. - Humana will provide telephone equipment appropriate to meet job requirements. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. - Occasional travel to Humana's offices for training or meetings may be required. Additional Information Typically reports to a Regional/Associate Vice President, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also contribute to grievance and appeals reviews. Some medical directors may join a centralized team for several months after training, until positions become available for specific markets. May participate on project teams or organizational committees.
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