Medical Director

Become a part of our caring community and help us put health firstThe Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.The Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work. The Medical Director works in a structured environment with expectations for consistency in thinking, authorship, meeting departmental expectations, and compliance timelines.Use your skills to make an impactRequired QualificationsMD or DO degreeCurrent and ongoing board certification in an approved ABMS Medical SpecialtyA current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment5+ years of direct clinical patient care experience post residency or fellowshipNo sanctions from Federal or State Governmental organizationsThe ability to pass credentialing requirementsExcellent verbal and written communication skills with analytic and interpretative skillsParticipate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contributionPreferred QualificationsExperience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age)Internal Medicine, Family Practice, Geriatrics, Physiatry, Emergency Medicine, Critical Care or hospital based clinical specialistsAbility to function in a dynamic fast paced environmentCommitment to a culture of innovationPassionate about contributing to an organization's focus on consistency in outcomes, consumer experiences, and a highly engaged team cultureKnowledge and experience with national guidelines such as NCD/LCD, MCG or InterQualThe Medical Director conducts clinical case reviews of requests received by members of the Medicare population and reports to the Lead Medical Director.Other duties:Identify medical management operational improvements, including those within the medical director areaParticipate in call rotation which may include weekend coverageDevelop collaborative relationships with Team and key partners within the Medicare Line of Business.Support Home Solutions as neededOther activities as assigned by the managing Medical DirectorTravel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours40Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$223,800 - $313,100 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: About usHumana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.