Lead Medical Director

🔥 59 minutes ago

🇺🇸 United States – Remote

💵 $270.8k - $378.8k / year

⏰ Full Time

🟠 Senior

👨‍⚕️ Medical Director

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • 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.

📋 Description

• Become a part of the caring community • The Lead Medical Director relies on medical background and reviews health claims • Requires solid understanding of how organization capabilities interrelate across departments • Provides clinical and operational leadership for medical review activities supporting Home Health, Skilled Nursing Facility, Durable Medical Equipment, Medicare/Medicaid dual-eligible requests, and related home care solutions • Ensures consistent, timely, fair, compliant, and evidence-based medical necessity determinations for Medicare, Medicaid, and Dual Eligible populations • Oversee daily operations of a team of Medical Directors conducting appeals and clinical case reviews for Medicare and Dual Eligible populations • Maintain Medical Director staffing schedules, including paid time off, weekend coverage, after-hours coverage, and call rotation planning • Conduct clinical case reviews for approximately 50% of the role’s responsibilities • Review Medicare, Medicaid, and Dual Eligible member cases to determine medical necessity and appropriateness of requested services

🎯 Requirements

• Doctor of Medicine (MD/DO) degree from an accredited university in the USA • Current and ongoing board certification in an approved ABMS Medical Specialty • Active unrestricted license in at least one jurisdiction and willing to obtain additional licenses, as required, for various states in region of assignment • 2+ years of leadership experience • 5+ years of direct clinical patient care experience post-residency or fellowship • No current sanction from Federal or State Governmental organizations and the ability to satisfy onboarding requirements • Excellent verbal and written communication skills with analytic and interpretative skills from prior experience focusing on quality, utilization, and/or case management • Knowledge and experience with national guidelines such as NCD/LCD, MCG® or InterQual

🏖️ Benefits

• Benefits starting day 1 of employment • Competitive 401k match • Generous Paid Time Off accrual • Tuition Reimbursement • Parental Leave