Physical Health Medical Director

🔥 0 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 execute Medicaid care strategy and/or operations • Use medical background, experience, and judgment to determine whether requested services, levels of care, or sites of service should be authorized • Perform computer-based reviews of clinical scenarios and submitted clinical records • Prioritize daily work and communicate decisions to internal associates • Participate in care management as needed • Conduct peer-to-peer discussions with external physicians to gather clinical information or discuss determinations • Support regional market priorities through discussions with physicians, physician groups, facilities, and community groups • Focus on collaborative business relationships, value-based care, population health, and disease or care management • Support Humana values and the enterprise social needs team mission • Provide cluster coverage 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 ABMS- or ABPN-recognized specialty • Current and unrestricted license in at least one state within the specific cluster • Ability to obtain licenses in other cluster states requiring licensure • 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 the accreditation process, including NCQA • Experience with CGX and MHK • Licensure through the Interstate Medical Licensure Compact • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Home internet with at least 25 Mbps download and 10 Mbps upload speed

🏖️ Benefits

• Bonus incentive plan based upon 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 • Personal wellness and smart healthcare decision support • Occasional travel to Humana offices for training or meetings may be required