Medical Director – Physical Health

🔥 10 minutes ago

🌽 Illinois, Kentucky, +3 more states – Remote

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

• Develop and support Medicaid care strategy and/or operations • Determine whether requested services, levels of care, or sites of service should be authorized • Apply national clinical guidelines, state policies, CMS policies, clinical references, and internal resources while ensuring regulatory compliance • Learn Medicaid requirements and operationalize them in daily work within the assigned cluster • Conduct computer-based review of complex clinical scenarios and submitted clinical records • Prioritize daily work and communicate decisions to internal associates • Participate in care management as needed for outpatient and inpatient clinical scenarios • Conduct phone discussions with external physicians to gather clinical information or discuss determinations through peer-to-peer processes • Resolve conflicts during physician discussions when necessary • Support regional market priorities through engagement with physicians, physician groups, facilities, and community groups • Support collaborative business relationships, value-based care, population health, disease management, and care management initiatives • Support Humana values and the enterprise social needs team mission • Provide coverage within the cluster for vacations, weekends, and holidays as needed • Report directly to the Cluster Lead Medical Director

🎯 Requirements

• Doctor of Medicine or Doctor of Osteopathy • Board-certified in an AOABPS or ABMS recognized medical specialty • Current and unrestricted license at the offer stage in at least one state in the assigned cluster • Ability to obtain licenses without conditions in the other cluster states based on assigned region: Indiana, Ohio, Kentucky, Virginia, Wisconsin, and Illinois • Able to satisfy onboarding requirements • At least five years of experience post-training providing clinical services • Experience in utilization management review and case management in a health plan setting • No current sanction from Federal or State Governmental organizations • Able to pass credentialing requirements • Experience working with Medicaid enrollees, providers, and stakeholders in a clinical or administrative setting • Experience with accreditation process (NCQA) • Experience with CGX and MHK • Licensure through the Interstate Medical Licensure Compact (IMLC) • Typical availability Monday-Friday, starting no later than 9am EST, with flexibility depending on business needs • Home internet with minimum download speed of 25 Mbps and upload speed of 10 Mbps • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Self-provided internet service for home or hybrid home/office employees • Occasional travel to Humana offices for training or meetings

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