Medical Director
2 days ago
Become a part of our caring community and help us put health first
The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs within a context of regulatory compliance, assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work.
The Medical Director’s work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, and communication of decisions to internal associates. The clinical scenarios predominantly arise from post-acute care environments. The work includes discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances, these may require conflict resolution skills.
ResponsibilitiesThe Medical Director provides medical interpretation and determinations on whether acute inpatient rehabilitation authorization requests are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues, and clinical leadership. After completion of structured and mentored training, daily work is performed with minimal direction, but with support from other team members. The Medical Director enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting enterprise expectations and compliance timelines.
This is a full-time work from home opportunity. Candidates may live anywhere in the US and work forty hours per week.
Required Qualifications- MD or DO degree
- 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to acute inpatient rehabilitation.
- Board Certified in an approved ABMS Medical Specialty with continued certification throughout employment.
- A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s), if required.
- No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
- Excellent verbal and written communication skills.
- Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, and acute inpatient rehabilitation.
- Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers.
- Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid.
- Physical Medicine and Rehabilitation, Internal Medicine, Family Practice, Geriatrics, or Hospitalist background.
- Advanced degree such as an MBA, MHA, or MPH.
- The curiosity to learn, the flexibility to adapt, and the courage to innovate.
Use your skills to make an impact
Additional InformationTypically reports to a Regional/Associate Vice President, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for several months after training, until positions become available for specific markets. May participate on project teams or organizational committees.
Work at Home GuidanceTo ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$223,800 - $313,100 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.
Description of BenefitsHumana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline02-13-2025
About UsHumana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.
Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our website for more information.
#J-18808-Ljbffr-
Medical Director
5 days ago
Cheyenne, United States Humana Full timeHumana Medical Director - Florida Cheyenne, Wyoming Apply Now Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth...
-
Medical Director
6 hours ago
Cheyenne, United States Humana Full timeHumana Medical Director - Gulf South Cheyenne , Wyoming Apply NowBecome a part of our caring community and help us put health firstThe Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth...
-
Medical Director for Inpatient Dialysis
3 weeks ago
Cheyenne, Wyoming, United States Physician Empire Full timeAt Physician Empire, we offer a unique opportunity for an experienced Medical Director to lead our inpatient dialysis center. This full-time position is based in Wyoming and comes with a competitive salary of $260,000 per year.Company OverviewOur hospital-employed group is dedicated to providing high-quality patient care in a serene natural setting. With no...
-
Medical Director
2 days ago
Cheyenne, United States Humana Full timeHumana Medical Director - OneHome/Home Health Cheyenne, WyomingBecome a part of our caring community and help us put health firstJob Description SummaryThe Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic, home health per diem, DME, and waiver requests. The Medical Director provides medical...
-
Cheyenne, Wyoming, United States Healthcare Connections Full timeWe are seeking a highly skilled and dedicated Medical Director to join our team of healthcare professionals at Healthcare Connections. This is an exciting opportunity for an Internal Medicine physician to lead our private practice and provide exceptional patient care in a supportive environment.About the RoleAs Medical Director, you will be responsible for...
-
Medical Director
6 hours ago
Cheyenne, United States Humana Full timeHumana Medical Director - Mid West Region Cheyenne , Wyoming Apply Now Become a part of our caring community and help us put health firstThe Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. All work...
-
Director of Medical Imaging
2 days ago
Cheyenne, United States Memorial Hospital of Laramie County Full timeJob DescriptionJob DescriptionA Day in the Life of a Director of Medical ImagingThe Medical Imaging Director provides management for Cheyenne Regional Medical Center's Medical Imaging services and ensures delivery of radiology technical operations and local administrative functions. Utilizes professional judgment, knowledge and leadership to develop new...
-
Medical Director Leadership Role
23 hours ago
Cheyenne, Wyoming, United States Humana Full timeAbout the Role: As a Medical Director at Humana, you will be responsible for leading clinical case reviews of requests received by members of the Medicare population. You will provide medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, and Humana...
-
Clinical Health Services Director
2 weeks ago
Cheyenne, Wyoming, United States NurseStar Medical Partners Full timeJob Title: Clinical Health Services DirectorSalary: $104,000 - $112,000 per year, plus an additional $20,000 for 24/7 on-call responsibilitiesWe are seeking a highly skilled and experienced RN to lead our medical unit at the County Jail. As a Clinical Health Services Director, you will be responsible for overseeing and providing direct nursing care to...
-
Medical Director for Family Medicine
3 weeks ago
Cheyenne, Wyoming, United States Physician Empire Full timeWe are seeking a skilled Family Medicine physician to lead our team at Physician Empire in Wyoming. As a Medical Director, you will have the opportunity to work with a hospital-employed group and gain colleague support from established professionals. You will also enjoy great office support, a welcoming community, and a supportive schedule for work-life...
-
Cheyenne, Wyoming, United States Physician Empire Full timeAt Physician Empire, we are seeking a highly skilled Medical Director to join our team in the beautiful state of Wyoming. This is an exceptional opportunity for a physician who wants to balance their career with a great quality of life.About the Role:We are looking for a board-certified psychiatrist with experience in child and adolescent psychiatry to lead...
-
Cheyenne, Wyoming, United States FCS - Psychiatric Recruitment Full timeJob Summary: FCS - Psychiatric Recruitment is proud to present a Medical Director Psychiatry Opportunity in Wyoming. We are seeking highly skilled and experienced psychiatrists to join our team. About the Role: This is a full-time General Adult and Addictions psychiatrist position at a 204-bed medical center in Southeast Wyoming. The ideal candidate will...
-
Medical Director for Wyoming Outpatient Clinic
3 weeks ago
Cheyenne, Wyoming, United States All Star Healthcare Solutions Full timeWe are seeking a skilled Internal Medicine physician to lead our team in central Wyoming. Our ideal candidate is a board-certified doctor with experience in outpatient medicine and a passion for delivering exceptional patient care.Role OverviewThis employed position offers a stable work environment, modern facilities, and state-of-the-art equipment. As a...
-
Cheyenne, Wyoming, United States All Star Healthcare Solutions Full timeWe are seeking a board-certified Internal Medicine physician to lead our growing team in central Wyoming. This employed outpatient position offers a stimulating work environment with state-of-the-art equipment and modern facilities.Competitive Compensation PackageThe estimated annual salary for this position is around $250,000, including a base salary of...
-
Medical Director Opportunity in Family Medicine
3 weeks ago
Cheyenne, Wyoming, United States All Star Healthcare Solutions Full timeJoin All Star Healthcare Solutions in a rewarding medical director opportunity as a family medicine physician in Wyoming.About the RoleThis exciting position offers a very competitive salary with production bonus incentives, including a sign-on bonus, retention bonus, paid relocation, paid malpractice, CME reimbursement, startup marketing, and a...
-
Director
2 months ago
Cheyenne, United States Sage Truck Driving School Full timeSeeking a highly motivated, experienced team player manager to lead day-to-day training operations for an established truck driver training program in Cheyenne, WY. The individual would report to a Regional Manager and also the President. The Director is responsible for the overall day-to-day and long-term administration and management of the program.What We...
-
Administrative Director
3 weeks ago
Cheyenne, Wyoming, United States DAK Resources Full timeJob SummaryWe are seeking a highly skilled Administrative Director to join our team at DAK Resources.About the Role:This position requires a seasoned leader with a strong background in healthcare administration, able to oversee multiple projects and prioritize tasks effectively.The successful candidate will have a minimum of five years of experience in a...
-
Medical Director
19 hours ago
Cheyenne, Wyoming, United States Oak Street Health Inc. Full time**About the Role**Oak Street Health is seeking an experienced Nurse Practitioner to join our team as an Advanced Practice Provider. In this role, you will provide high-quality primary care to older adults on Medicare, with a focus on keeping patients healthy and living life to the fullest.**Key Responsibilities**Provide exceptional primary care to patients...
-
Healthcare Billing Director
3 weeks ago
Cheyenne, Wyoming, United States Memorial Hospital of Laramie County Full timeJob OverviewCheyenne Regional Medical Center seeks a skilled Billing Services Director to lead and plan within the billing departments, overseeing and streamlining billing and collections processes. This role requires a strong hands-on leader with the ability to prioritize, plan, and direct Hospital, Professional, and Single Billing Office Departments.
-
Assistant Director of Nursing
5 days ago
Cheyenne, United States Cottonwood Healthcare and Rehabilitation Center Full timeAssistant Director of Nursing at Cottonwood Healthcare and Rehabilitation Center summary: The Assistant Director of Nursing at Cottonwood Healthcare and Rehabilitation in Laramie, WY, is responsible for overseeing daily operations within the clinical department, hiring and training staff, and assessing resident needs. This role is critical in providing...