Medical Director – Medicaid

October 26

🐎 Kentucky – Remote

Although this job is listed in Kentucky, this company may be open to hiring remote in other states.

🏈 Ohio – Remote

Although this job is listed in Ohio, this company may be open to hiring remote in other states.

+2 more states

🐎 Kentucky – Remote 🏈 Ohio – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

💵 $223.8k - $313.1k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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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 relies on medical background and reviews health claims. • Involves moderately complex to complex issues where analysis of situations or data requires evaluation of variable factors. • Makes determinations whether requested services and/or level of care should be authorized. • Acts within a context of regulatory compliance and uses diverse resources. • Reviews clinical scenarios, prioritizes daily work, communicates decisions to internal associates. • Engages with external physicians to gather clinical information or discuss determinations through the Peer 2 Peer process.

🎯 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 KY or willing to obtain by start date • Willingness to obtain additional license(s), as required • No current sanction from Federal or State Governmental organizations • Excellent verbal and written communication skills • Evidence of analytic and interpretation skills • Prior 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 and many other opportunities