Medical Director

🕒 July 8

🇺🇸 United States – Remote

💵 $223.8k - $313.1k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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👻 Ghost score 55%

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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

• Review clinical cases and determine medical necessity of services for Medicare and Medicaid members • Ensure compliance with review policies, procedures, and regulatory standards • Apply clinical guidelines, CMS policies, and Medicare, Medicare Advantage, and Medicaid requirements • Identify opportunities for medical management operational improvements • Participate in call rotations, including weekend and after-hours coverage • Contribute to a collaborative team culture supporting organizational excellence • Deliver exceptional consumer experiences • Attend required conferences and create educational content for subject-matter contribution • Support Home Solutions and other activities assigned by OneHome leadership • Report to the Lead Medical Director • Work within defined timelines and departmental expectations

🎯 Requirements

• MD or DO degree • Current, active and ongoing board certification from ABMS or AOABPS; NBPAS certification is not accepted • Current and unrestricted state medical license in at least one state, with willingness to obtain additional licenses as required • No sanctions from Federal or State Governmental organizations • 5 years of direct clinical patient care experience post residency or fellowship • Ability to pass credentialing requirements • Intermediate to advanced Microsoft Office and Internet navigation skills • Strong verbal and written communication skills • Ability to analyze information and interpret data clearly and accurately • Adaptability and willingness to learn new technologies • Ability to work 40 hours per week, Monday through Friday, 8:00 AM to 5:00 PM • Availability for call rotations, including weekend and after-hours coverage • Ability to work in the local/residing time zone after training • Ability to complete 5 weeks of onboarding with no time off; training is in EST • Home internet with at least 25 Mbps download and 10 Mbps upload speeds • Dedicated workspace without ongoing interruptions to protect PHI/HIPAA information

🏖️ 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 • Remote work at home • 5 weeks of onboarding training • Occasional travel to Humana offices for training or meetings • Internet service requirements and dedicated workspace support for home employees

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