Physician Medical Director
2 weeks ago
Become a part of our caring community and help us put health first
The Long-term services and supports (LTSS) Medical Director's primary responsibility is the review of medical authorizations to determine the medical necessity of a given service, level of care, or medical item/supply. The Medical Director's work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors that rely on clinical experience and knowledge of both medicine and social determinants of health. Candidates must have current/active Florida license and be willing to work East Coast hours.
Use your skills to make an impact
Responsibilities
- The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.
- Supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services.
- Conducts clinical reviews of the care received by members in assigned LTSS Medicaid states, member population, or condition type.
Required Qualifications
- 5+ years of clinical experience
- Must have a current License in Florida and able to obtain License/s in Indiana, Virginia, Georgia, and/or other LTSS Medicaid states as needed
- MD or DO degree
- Board Certified in an approved ABMS Medical Specialty
- Excellent communication skills with 5+ years of established clinical experience
- Knowledge of the managed care industry including Medicare or Medicaid products
- Possess analysis and interpretation skills with 5+ years of experience focusing on quality management, utilization management, discharge planning, rehabilitation services, and/or home health services
Preferred Qualifications
- LTSS medical management organizations, Skilled Nursing Facilities, Long Term Care Facilities, Hospice, PACE, or Home Health Agencies and experience, working with health insurance other healthcare providers, patient interaction, etc.
- Internal Medicine, Physiatry, Family Practice, Geriatrics, Pediatrics, or Hospitalist experience
- Previous Medicare, Medicaid, and/or Commercial with 5+ years of experience
- Long Term Services & Supports or LTC/SNF with 5+ years of experience preferred
Scheduled Weekly Hours
40
Pay Range
$223,800 - $313,100 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers 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.
Application Deadline
03-31-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It 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.
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