Medical Director – National UM Team, Alternate Weekends

November 15

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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

• The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. • Reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. • Regular discussions with external providers by phone to gather additional clinical information and discuss determinations. • Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services. • Maintain accountability for productivity, quality, and compliance metrics. • Communicate determinations clearly both verbally and in writing. • Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices.

🎯 Requirements

• MD or DO degree • 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). • Current and ongoing Board Certification in an approved ABMS Medical Specialty • A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. • No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. • Excellent verbal and written communication skills. • Evidence of analytic and interpretation skills, with prior experience working in a team environment.

🏖️ 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 and many other opportunities