Medical Director – Trainer

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $246.1k - $344.2k / 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, coordinate, and deliver comprehensive onboarding and job-skills training for newly hired Grievances and Appeals Medical Directors • Provide virtual instruction on clinical review processes, authorization determinations, documentation expectations, and case decision-making standards • Train Medical Directors to apply medical judgment, clinical experience, and evidence-based resources when determining whether requested services should be authorized • Educate trainees on national clinical guidelines, CMS references, HMCP Medicare Advantage policies, Medicaid handbooks, clinical reference materials, and other applicable resources • Reinforce regulatory compliance requirements related to grievances, appeals, utilization management, documentation, and decision rationale • Respond to trainee questions on clinical, operational, regulatory, and policy-related topics • Provide individualized coaching, feedback, and support to newly hired Medical Directors • Collaborate with Clinical Operations leadership, Corporate, Division and Market leaders, Humana’s Learning Center, Risk and Compliance, Audit, Legal, the UM Center of Excellence, Lead Medical Directors, and other partners • Support quality auditing by reviewing training outcomes, identifying performance trends, and assisting with education or remediation plans • Coordinate and communicate MCG updates and explain changes to clinical criteria • Assist with Clinical Criteria Committee development and education • Support inter-rater reliability development, required meetings, teaching conferences, operational initiatives, and other activities promoting consistency, accuracy, and compliance

🎯 Requirements

• MD or DO degree from an accredited university • Active and unrestricted license in at least one jurisdiction • Willingness and ability to obtain an unrestricted license, as required, for various states in the region of assignment • Board Certified in an approved ABMS or AOA Medical Specialty • Monday-Friday schedule with weekend and holiday work as assigned • Excellent verbal and written communication skills that are prompt and professional with internal and external stakeholders • 5 years of established post-residency clinical experience • Knowledge of the managed care industry, including Medicare, Medicaid and/or Commercial products • Passion for contributing to an organization focused on continuously improving consumer experiences • Medical utilization management experience preferred • Experience working with health insurance organizations, hospitals and healthcare providers preferred • Patient interaction experience preferred • Preferred clinical specialties include Internal Medicine, Family Practice, Geriatrics, Hospitalist, Anesthesiology, Physical Medicine and Rehabilitation, Emergency Medicine, Neurology, and General Surgery • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • 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 • Remote work arrangement • Home office work with dedicated workspace • Occasional travel to Humana offices for training or meetings