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Medical Director
2 weeks ago
The Medical Director plays a critical role in ensuring the delivery of high-quality, patient-centered care within our organization. This position is responsible for providing medical interpretation and determinations regarding services provided by other healthcare professionals, in alignment with national guidelines, CMS requirements, and Humana policies.
This leadership role supports collaboration with various teams, including clinical operations, quality management, and utilization review. The ideal candidate will possess strong analytical and communication skills, with experience participating in teams focused on quality management, case management, and discharge planning.
Key Responsibilities:
- Provide medical expertise to support clinical decision-making and ensure compliance with regulatory requirements.
- Collaborate with cross-functional teams to develop and implement clinical programs that promote quality care and reduce costs.
- Maintain knowledge of national guidelines, CMS policies, and Humana's clinical standards.
Requirements
To be successful in this role, you must have:
- A Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
- At least 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 certification in an approved ABMS medical specialty and ongoing certification throughout employment.
- A current, unrestricted medical license in at least one jurisdiction and willingness to obtain additional licenses as required.
- No current sanctions from federal or state governmental organizations and ability to pass credentialing requirements.
- Excellent verbal and written communication skills.
- Evidence of analytical and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning, and/or home health or post-acute services.