Medical Director – Nat’l OP Medicare

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Humana

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Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

📋 Description

• Provides medical interpretation and determinations whether services are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards • Supports and collaborates with other team members and other departments • Engages in discussions with external physicians to gather clinical information or discuss determinations • Conducts Utilization Management of the care received by members in assigned markets

🎯 Requirements

• MD or DO degree • 5+ years of direct clinical patient care experience post residency or fellowship • Current and ongoing Board Certification in an approved ABMS Medical Specialty • A current and unrestricted license in at least one jurisdiction • No current sanction from Federal or State Governmental organizations • Excellent verbal and written communication skills • Evidence of analytic and interpretation skills • Experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services

🏖️ 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