One - Medical Director - Part Time

Become a part of our caring community and help us put health first

The 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.

• MD or DO degree
• Current and ongoing board certification through an approved ABMS or AOABPS Medical Specialty is a requirement. NBPAS certification is not accepted.
• A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment
• 5+ years of direct clinical patient care experience post residency or fellowship
• No sanctions from Federal or State Governmental organizations
• The ability to pass credentialing requirements
• Excellent verbal and written communication skills with analytic and interpretative skills
• Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution

• Experience 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 specialists
• Ability to function in a dynamic fast paced environment
• Commitment to a culture of innovation
• Passionate about contributing to an organization’s focus on consistency in outcomes, consumer experiences, and a highly engaged team culture
• Knowledge and experience with national guidelines such as NCD/LCD, MCG® or Inter Qual

The Medical Director conducts clinical case reviews of requests received by members of the Medicare population and reports to the Lead Medical Director.

• Identify medical management operational improvements, including those within the medical director area
• Participate in call rotation which includes weekend coverage
• Develop collaborative relationships with Team and key partners within the Medicare Line of Business.
• Support Home Solutions as needed
• Other activities as assigned by the managing Medical Director

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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The 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 year

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident.

Final date to receive applications:…