Medical Director - Nat'l UM Team 1wknd/mo

Humana; Brasil; Teletrabalho; BRL 1.207.000 - 1.690.000; Tempo integral

Resumo da oferta

A leading health services company is seeking a Medical Director who will utilize their medical expertise to authorize services in a compliance context. Candidates require an MD or DO degree, 5+ years of clinical experience, and excellent communication skills. Weekend work is mandatory once a month, and the position is primarily remote with occasional office visits. Competitive compensation is offered, including a bonus incentive plan based on performance.

Serviços

Medical, dental, and vision coverage

401(k) retirement savings plan

Paid time off and holidays

Qualificações

• 5+ years of direct clinical patient-care experience post-residency or fellowship, preferably in an inpatient environment.
• Active and unrestricted license in at least one jurisdiction.
• No current sanctions from Federal or State governmental organizations.

Responsabilidades

• Review all submitted medical records and provide expert decisioning.
• Communicate determinations clearly both verbally and in writing.
• Engage in discussions with external providers to gather clinical information.

Conhecimentos

Analytic skills

Excellent communication skills

Teamwork

Formação académica

MD or DO degree

Board Certification in an approved ABMS Medical Specialty

Descrição da oferta de emprego

Overview

The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. All work occurs within a regulatory compliance context and is assisted by diverse resources, including national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources.

Medical Directors learn Medicare and Medicare Advantage requirements and understand how to operationalize this knowledge daily.

Weekend work is required one weekend per month with compensated days off during the work week.

Responsibilities

• Review all submitted medical records, synthesize complex hospital‑based clinical scenarios, and provide expert decisioning on requested services.
• Engage in regular discussions with external providers by phone to gather additional clinical information and discuss determinations.
• Understand Humana processes and maintain collaborative professional relationships.
• 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.
• Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices.
• Exercise independence in meeting departmental expectations and compliance timelines.
• Weekend work is required one weekend per month with compensated days off during the work week.

Qualifications

Required Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient‑care experience post‑residency or fellowship, preferably in an inpatient environment and/or in care of a Medicare‑type population.
• Current and ongoing Board Certification in an approved ABMS Medical Specialty.
• Active and unrestricted license in at least one jurisdiction; willing to obtain additional license if required.
• No current sanctions 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.

Preferred Qualifications

• Knowledge of the managed‑care industry, including Medicare Advantage, Managed Medicaid, or Commercial products, and other medical‑management organizations.
• Utilization‑management experience in a medical‑management review organization.
• Experience with national guidelines such as MCG® or InterQual.
• Hospital‑based clinical practice experience, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital‑based clinical specialists.
• Curiosity to learn and flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals.
• Ability to thrive in a dynamic fast‑paced, team‑oriented environment.
• Commitment to a culture of innovation, including being facile with using technology to improve workflows.
• Participation in educational activities by attending required conferences and by creating content to lead/teach/present for individual subject‑matter contribution.
• Passion for contributing to an organization’s focus on consistency in outcomes, consumer experiences, and a highly engaged team culture.

Additional Information

• The medical director reports to a Lead Medical Director.
• Participation in weekend work on a rotational basis to ensure cases are decisioned in a timely manner.
• May participate on project teams or organizational committees.
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Schedule & Compensation

Scheduled weekly hours: 40.

Pay range: $223,800 – $313,100 per year (full‑time, 40 hours per week). This range may vary by geography and individual qualifications. The position is eligible for a bonus incentive plan based upon company and/or individual performance.

Benefits

Humana offers competitive benefits that support whole‑person well‑being. Benefits include medical, dental, and vision coverage; 401(k) retirement savings plan; paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave; short‑term and long‑term disability; life insurance; and many other opportunities.

Application Deadline: 04‑30‑2026.

About Us

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.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.