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Medical Director

2 weeks ago


Nashville, Tennessee, United States Humana Full time

We are seeking a highly experienced and skilled Medical Director to join our team. In this role, you will be responsible for providing medical interpretation and determinations on services provided by healthcare professionals, ensuring they align with national guidelines, CMS requirements, Humana policies, and clinical standards.

About this role

This position requires a strong medical background, excellent verbal and written communication skills, and the ability to work independently and collaboratively as part of a team. We are looking for a highly skilled professional who can support and collaborate with other departments, Humana colleagues, and the Regional VP Health Services.

Key responsibilities
  • Conduct Utilization Management of care received by members in an assigned market, member population, or condition type.
  • Support regional market priorities, including an understanding of Humana processes and collaborative business relationships, value-based care, population health, or disease management.
  • Work closely with external physicians, physician groups, facilities, or community groups to ensure high-quality care and service delivery.
Requirements
  • MD or DO degree with 5+ years of direct clinical patient care experience post-residency or fellowship, preferably in an inpatient environment and/or related to care of a Medicare-type population.
  • Board Certified in an approved ABMS Medical Specialty with continued certification throughout employment.
  • A current and unrestricted license in at least one jurisdiction, with willingness to obtain additional licenses if required.
  • No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.