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Medical Director Leadership Role

1 week ago


Raleigh, North Carolina, United States Humana Full time

The Medical Director will lead clinical interpretation and determinations, ensuring services align with national guidelines, CMS requirements, and Humana policies. Ideal candidates will support team collaboration, maintain consistency in thinking and authorship, and meet compliance timelines.

Responsibilities
  • Provide medical interpretation and determinations for services provided by healthcare professionals.
  • Collaborate with team members, other departments, and stakeholders to achieve shared goals.
  • Exercise independence in meeting departmental expectations and maintaining compliance.

Required Qualifications

  • MD or DO degree
  • 5+ years of direct clinical patient care experience post residency or fellowship
  • Board Certified in an approved ABMS Medical Specialty
  • A current and unrestricted license in at least one jurisdiction
  • No current sanction from Federal or State Governmental organizations