Medical Director

November 27

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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

• Rely on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare/Medicaid and Waiver requests • Provide medical interpretation and determinations about the appropriateness of services provided by other healthcare professionals • Learn Medicare and Medicare Advantage requirements and operationalize this knowledge in daily work • Work in a structured environment with expectations for consistency in thinking, authorship, meeting departmental expectations, and compliance timelines • Conduct clinical case reviews of requests received by members of the Medicare population • Identify medical management operational improvements • Participate in call rotation which includes weekend coverage • Develop collaborative relationships with Team and key partners within the Medicare Line of Business

🎯 Requirements

• MD or DO degree • Current and ongoing board certification through an approved ABMS or AOABPS Medical Specialty • A current and unrestricted license in at least one jurisdiction • 5+ years of direct clinical patient care experience post residency or fellowship • No sanctions from Federal or State Governmental organizations • The ability to pass credentialing requirements • Excellent verbal and written communication skills with analytic and interpretative skills

🏖️ 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