Medical Director – Acute Rehab

🔥 4 minutes ago

🇺🇸 United States – Remote

💵 $223.8k - $313.1k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ 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

• Determine whether to authorize requested services, level of care, and site of service • Conduct computer-based reviews of moderately complex to complex clinical scenarios • Review submitted clinical records and prioritize daily work • Communicate decisions to internal associates • Provide medical interpretation and determinations on acute inpatient rehabilitation authorization requests • Ensure alignment with national clinical guidelines, CMS requirements, Humana policies, and clinical standards • Collaborate with team members, departments, Humana colleagues, and clinical leadership • Participate in structured and mentored training programs • Apply critical thinking and maintain high standards in documentation and decision-making • Meet enterprise expectations and compliance timelines independently • Conduct utilization management of care received by members in an assigned market, population, or condition type • Contribute to grievance and appeals reviews • Participate on project teams or organizational committees • Discuss cases with external physicians by phone and gather additional clinical information • Resolve conflicts when needed

🎯 Requirements

• MD or DO degree • 5+ years of direct clinical patient care experience after residency or fellowship • Board Certified in an approved ABMS or AOA Medical Specialty, with continued certification throughout employment • Current and unrestricted license in at least one jurisdiction, with willingness to obtain additional licenses • No current sanction from Federal or State Governmental organizations • Ability to pass credentialing requirements • Analytic and interpretation skills • Prior experience participating in teams focused on quality management, utilization management, and acute inpatient rehabilitation • Knowledge of the managed care industry, including Medicare Advantage, Managed Medicaid, hospitals/Integrated Delivery Systems, health insurance, and healthcare providers • Utilization management experience in a medical management review organization • Background in Physical Medicine and Rehabilitation, Internal Medicine, Family Practice, Geriatrics, or Hospitalist practice • Applicants must live in the contiguous United States • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information • Home internet service with at least 25 Mbps download and 10 Mbps upload speed • Preferred: advanced degree such as MBA, MHA, or MPH • Preferred: exposure to Public Health, Population Health, analytics, and business metrics • Preferred: experience working with Case managers or Care managers on complex case management and familiarity with social determinants of health

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental, and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Work-from-home arrangement • Occasional travel to Humana offices for training or meetings