Medical Director

4 weeks ago


Helena, Montana, United States Humana Full time
Job Summary

We are seeking a highly skilled Medical Director to join our team at Humana. As a Medical Director, you will be responsible for leading the clinical review process and making determinations on whether requested services, level of care, and site of service should be authorized at the inpatient level.

Key Responsibilities
  • Lead the clinical review process and make determinations on inpatient services
  • Use medical background, experience, and judgment to make informed decisions
  • Collaborate with internal teams and external physicians to gather additional clinical information and discuss determinations
  • Participate in care management and prioritize daily work
  • Communicate decisions to internal associates and participate in project teams or organizational committees
Requirements
  • MD or DO degree
  • 5+ years of direct clinical patient care experience post-residency or fellowship
  • Board certification in an approved ABMS medical specialty
  • Current and unrestricted license in at least one jurisdiction
  • Excellent verbal and written communication skills
  • Evidence of analytic and interpretation skills
Preferred Qualifications
  • Understanding of Medicare Inpatient Guidelines
  • Knowledge of the managed care industry
  • Utilization management experience in a medical management review organization
  • Experience with national guidelines such as MCG or InterQual
  • Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialization
About Humana

Humana is committed to putting health first for our teammates, customers, and company. We make it easier for the millions of people we serve to achieve their best health through our Humana insurance services and CenterWell healthcare services.

We are an equal opportunity employer and comply with all applicable federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion.



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