PCO Medical Director – Part Time

November 7

Apply Now

Receive Emails with Similar Jobs

Humana

WebsiteLinkedInAll Job Openings

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

• relies on medical background and reviews health claims • work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors • makes determinations whether requested services, requested level of care, and/or requested site of service should be authorized • conducts 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 • participates in care management and possible care facilitation with hospitals • may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market care facilitation and priorities

🎯 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 as well as ABQAURP, or other board demonstrating advanced training in transitions of care, quality assurance, utilization management and care coordination • 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 organizational, verbal and written communication skills • Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on transitions of care, quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation.

🏖️ Benefits

• paid time off • 401(k) retirement savings plan • employee assistance program • business travel and accident