Medical Director

🔥 10 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

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/Medicaid requirements. • Identify opportunities for medical management operational improvements. • Participate in call rotations, including weekend coverage and after-hours coverage. • Contribute to an engaged, collaborative team culture that supports organizational excellence. • Deliver exceptional consumer experiences. • Participate in educational activities by attending required conferences and creating content to present for individual subject matter contribution. • Support Home Solutions and other activities as assigned by the OneHome leadership.

🎯 Requirements

• MD or DO degree • Current, active and ongoing board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialties (AOABPS). National Board of Physicians & Surgeons (NBPAS) certification is not accepted. • Current and unrestricted state license in at least one state and willing to obtain other medical licenses, as required, for various states in region of assignment. • No sanctions from Federal or State Governmental organizations • 5 years of direct clinical patient care experience post residency or fellowship. • The ability to pass credentialing requirements. • Intermediate to advanced skills utilizing Microsoft Office and Internet navigation. • Strong verbal and written communication skills, with the ability to analyze information and interpret data clearly and accurately. • Adaptable and willing to learn new technologies to enhance workflow efficiency.

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance and many other opportunities