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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.

Medical Director – National IP UM Team

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

Location

United States

Posted

124 days ago

Salary

$223.8K - $313.1K / year

Seniority

Lead

Postgraduate Degree5 yrs expEnglish

Job Description

• Actively use medical background and experience to make determinations regarding authorization of services • Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services • Maintain accountability for productivity, quality, and compliance metrics • Communicate determinations clearly both verbally and in writing • Participate in rotational weekend work and occasional holiday responsibilities • Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices

Job Requirements

  • MD or DO degree
  • 5+ years of direct clinical patient care experience post residency or fellowship, 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, with prior experience working in a team environment

Benefits

  • Medical, dental and vision benefits
  • 401(k) retirement savings plan
  • Paid 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

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