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Medical Services Director
1 week ago
We are seeking a highly skilled Medical Director to join our team at Humana. The successful candidate will be responsible for providing medical interpretation and determinations, supporting team members, and engaging in grievance and appeals reviews.
Responsibilities:
- Review submitted medical records, synthesize complex hospital-based clinical scenarios, and provide expert decisioning on requested services.
- Collaborate with external providers to gather additional clinical information and discuss determinations.
- Participate on project teams or organizational committees, and engage in continuous learning and professional development.
Qualifications:
- MD or DO degree.
- 5+ years of direct clinical patient care experience post residency or fellowship.
- Current and ongoing Board Certification in an approved ABMS Medical Specialty.
- A current and unrestricted license in at least one jurisdiction and willingness to obtain additional licenses if required.
Preferred Qualifications:
- Knowledge of the managed care industry, including Medicare Advantage, Managed Medicaid, and Commercial products.
- Experience with utilization management, quality management, case management, discharge planning, and home health or post-acute services.
- Ability to thrive in a dynamic fast-paced, team-oriented environment.