Humana

Humana 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.

Medical Director – Medicaid

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 10,001+Since 1961H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

59 days ago

Salary

$223.8K - $313.1K / year

Seniority

Lead

Postgraduate Degree5 yrs expEnglish

Job Description

• rely on medical background and review health claims • make determinations whether requested services, requested level of care, and/or requested site of service should be authorized • learn Medicare and Medicare Advantage requirements • operationalize knowledge in daily work • conduct computer based review of moderately complex to complex clinical scenarios • review submitted clinical records • prioritize daily work • communicate decisions to internal associates • participate in care management • speak with external physicians to gather clinical information or discuss determinations • overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services

Job Requirements

  • MD or DO degree
  • 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age)
  • Current and ongoing Board Certification in an approved ABMS Medical Specialty
  • A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required
  • No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
  • Excellent verbal and written communication skills
  • Evidence of analytic and interpretation skills
  • Prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.

Benefits

  • 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
  • many other opportunities

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