Remote Medical Director, Acute Rehab

Humana Inc; Dover (DE); À distance; USD 224 000 - 313 000; Plein temps

Résumé du poste

Humana Inc. is seeking a Medical Director to authorize services and determine level of care for DSNP, applying CMS guidelines and Humana policies to drive compliant decisions. The role focuses on review of moderately complex clinical scenarios and coordination with external physicians as needed.

This fully remote position requires an MD or DO with 5+ years of clinical experience, board certification, and a current license. Occasional travel for training may be required; 40 hours weekly.

Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care experience post residency or fellowship.
• Board Certified in an ABMS or AOA specialty with continued certification.
• A current and unrestricted license in at least one jurisdiction.
• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
• Evidence of analytic and interpretation skills, with prior experience in quality management, utilization management, and acute inpatient rehabilitation.
• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid, or other medical management organizations.
• Utilization management experience in a medical management organization (e.g., Medicare Advantage).
• Background in Physical Medicine and Rehabilitation, Internal Medicine, Family Practice, Geriatrics, or Hospitalist.

Responsabilités

• Provide medical interpretation and determinations on acute inpatient rehabilitation authorization requests, ensuring alignment with national clinical guidelines, CMS requirements, Humana policies, and clinical standards.
• Collaborate with team members, other departments, Humana colleagues, and clinical leadership to support the review process and facilitate quality outcomes.
• Participate in and complete structured and mentored training programs; utilize ongoing team support during daily work activities.
• Consistently apply critical thinking and maintain high standards in documentation and decision-making within a structured work environment.
• Exercise independence in fulfilling enterprise expectations and meeting compliance timelines.
• This is a full-time, remote position with a standard schedule of forty hours per week; the role may be performed from any location within the United States.

Connaissances

Analytic interpretation skills

Utilization management

Managed care knowledge

Communication with teams/external MDs

Formation

MD or DO

Board Certified (ABMS/AOA)

Active medical license

Description du poste

Humana Inc. is seeking a Medical Director to authorize services and determine level of care for DSNP, applying CMS guidelines and Humana policies to drive compliant decisions. The role focuses on review of moderately complex clinical scenarios and coordination with external physicians as needed.

This fully remote position requires an MD or DO with 5+ years of clinical experience, board certification, and a current license. Occasional travel for training may be required; 40 hours weekly.