Medical Director - Acute Rehab Team

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

The Medical Director uses their medical background, experience, and judgement to determine whether to authorize requested services, requested level of care, and requested site of service. All work occurs within a context of regulatory compliance, and diverse resources assist work, including national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work specifically for DSNP.

The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, and communication of decisions to internal associates. The clinical scenarios predominantly arise from post-acute care environments. The work includes discussions with external physicians by phone to gather additional clinical information or discuss determinations, and in some instances, these may require conflict resolution skills.

The Medical Director provides medical interpretation and determinations on whether acute inpatient rehabilitation authorization requests are in agreement with national guidelines, CMS requirements, Humana policies, and clinical standards. You support and collaborate with other team members, other departments, Humana colleagues and clinical leadership. After completion of structured and mentored training, team members provide support while you perform daily work. The Medical Director enjoys working in a structured environment with expectations for consistency in thinking and authorship.

Exercise independence in meeting enterprise expectations and compliance timelines.

This is a full-time work from home opportunity. You may live anywhere in the US and work forty hours per week.

• 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 related to acute inpatient rehabilitation.
• Board Certified in an approved ABMS or AOA Medical Specialty with continued certification throughout employment.
• A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s).
• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
• Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, and acute inpatient rehabilitation.
• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers.
• Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid.
• Physical Medicine and Rehabilitation, Internal Medicine, Family Practice, Geriatrics, or Hospitalist background
• Advanced degree such as an MBA, MHA, or MPH
• The curiosity to learn, and the courage to innovate

Use your skills to make an impact

Typically reports to a Regional/Associate Vice President, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also contribute to grievance and appeals reviews. Some medical directors may join a centralized team for several months after training, until positions become available for specific markets.

May participate on project teams or organizational committees.

To ensure Home or Hybrid Home/Office associates, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can only be used if leadership approves it.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet our requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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

40

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week)…