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Humana logo
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

Physician Medical Director – LTSS

Location

Florida + 2 moreAll locations: Florida | Michigan | Virginia

Posted

116 days ago

Salary

$223.8K - $313.1K / year

Seniority

Lead

Professional Certificate5 yrs expEnglish

Job Description

Physician Medical Director – LTSS

Humana

• review of medical authorizations • determines the medical necessity of given service, level of care, or medical item/supply • conduct clinical reviews of care received by members in assigned LTSS Medicaid states • provide medical interpretation and determinations whether services are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and contracts • support and collaborate with other team members, other departments, Humana colleagues and the Regional VP Health Services • work in a structured environment with expectations for consistency in thinking and authorship • exercise independence in meeting departmental expectations and compliance timelines

Job Requirements

  • 5+ years of direct clinical patient care experience post residency or fellowship experience
  • Must have a current and unrestricted License in Florida and able to obtain Licenses in Indiana, Virginia, Georgia, Michigan, and other LTSS Medicaid states
  • MD or DO degree
  • Current and ongoing Board Certification in an approved ABMS/AOA Medical Specialty
  • 5+ years of established clinical experience
  • Knowledge of the managed care industry including Medicare or Medicaid products
  • Have interpretation skills with 5+ years of experience focusing on quality management, utilization management, discharge planning, rehabilitation services, and home health services
  • No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
  • LTSS medical management organizations, Skilled Nursing Facilities, Long-term Care Facilities, Hospice, PACE, or Home Health Agencies and experience, working with health insurance other healthcare providers, and patient interaction.
  • Internal Medicine, Physiatry, Family Practice, Geriatrics, Pediatrics, or Hospitalist experience
  • Previous Medicare, Medicaid, and Commercial with 5+ years of experience
  • Long-term Services & Supports or LTC/SNF with 5+ years of experience

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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