Remote Medical Director - Acute Rehab Leader

Humana Inc; Honolulu (HI); Remote; USD 224.000 - 313.000; Vollzeit

Zusammenfassung

Humana Inc. is seeking a Medical Director to authorize services and levels of care for DSNP, using CMS guidelines and Humana policies. The role involves reviewing complex clinical cases, examining records, and discussing determinations with external physicians as needed.

The position is full-time and remote, with a 40-hour work week and possible occasional travel. Requires MD/DO, board certification, unrestricted license, and knowledge of managed care and inpatient rehab settings.

Qualifikationen

• MD or DO degree and active license required.
• Board certification in an ABMS or AOA specialty; continued certification expected.
• Experience in acute inpatient rehabilitation and managed care environment preferred.

Aufgaben

• Provide medical interpretation and determinations on rehabilitation authorization requests.
• Collaborate with teams and leadership to support the review process and quality outcomes.
• Participate in structured training and maintain thorough documentation and timelines.
• Exercise independence to meet enterprise expectations and compliance timelines.
• Remote full-time role with up to 40 hours per week; may travel to Humana offices occasionally.

Kenntnisse

Clinical decision making

Utilization management

Team collaboration

Regulatory knowledge

Ausbildung

MD or DO degree

Board Certified in ABMS/AOA

Current unrestricted license

Experience in acute inpatient rehabilitation

Analytic and interpretation skills

Medicare Advantage / Managed Medicaid knowledge

Utilization management experience

PM&R / Internal Medicine / Family Practice / Geriatrics / Hospitalist

Jobbeschreibung

Humana Inc. is seeking a Medical Director to authorize services and levels of care for DSNP, using CMS guidelines and Humana policies. The role involves reviewing complex clinical cases, examining records, and discussing determinations with external physicians as needed.

The position is full-time and remote, with a 40-hour work week and possible occasional travel. Requires MD/DO, board certification, unrestricted license, and knowledge of managed care and inpatient rehab settings.