Humana logo
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.

Physician Medical Director – LTSS

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

Location

Florida + 2 moreAll locations: Florida, Michigan, Virginia

Posted

22 days ago

Salary

$223.8K - $313.1K / year

Seniority

Lead

Professional Certificate5 yrs expEnglish

Job Description

• review of medical authorizations • determines the medical necessity of given service, level of care, or medical item/supply • conduct clinical reviews of care received by members in assigned LTSS Medicaid states • provide medical interpretation and determinations whether services are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and contracts • support and collaborate with other team members, other departments, Humana colleagues and the Regional VP Health Services • work in a structured environment with expectations for consistency in thinking and authorship • exercise independence in meeting departmental expectations and compliance timelines

Job Requirements

  • 5+ years of direct clinical patient care experience post residency or fellowship experience
  • Must have a current and unrestricted License in Florida and able to obtain Licenses in Indiana, Virginia, Georgia, Michigan, and other LTSS Medicaid states
  • MD or DO degree
  • Current and ongoing Board Certification in an approved ABMS/AOA Medical Specialty
  • 5+ years of established clinical experience
  • Knowledge of the managed care industry including Medicare or Medicaid products
  • Have interpretation skills with 5+ years of experience focusing on quality management, utilization management, discharge planning, rehabilitation services, and home health services
  • No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
  • LTSS medical management organizations, Skilled Nursing Facilities, Long-term Care Facilities, Hospice, PACE, or Home Health Agencies and experience, working with health insurance other healthcare providers, and patient interaction.
  • Internal Medicine, Physiatry, Family Practice, Geriatrics, Pediatrics, or Hospitalist experience
  • Previous Medicare, Medicaid, and Commercial with 5+ years of experience
  • Long-term Services & Supports or LTC/SNF with 5+ years of experience

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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