Remote Medical Director – Inpatient Utilization & Compliance

Humana Inc; Harrisburg (Dauphin County); Remote; USD 224.000 - 313.000; Vollzeit

Benefits dieser Stelle

Bonus incentive plan

Competitive benefits

Zusammenfassung

Humana Inc. is seeking a Medical Director to review inpatient and post-acute care requests, determine eligibility, and ensure alignment with national guidelines and CMS requirements.

The role emphasizes collaboration with teams, ongoing credentialing, and clinical documentation oversight. The position supports Medicare/Medicaid/Medicare Advantage programs, offers a compensation range of $223,800 to $313,100 per year, and a bonus incentive plan.

Qualifikationen

• MD or DO degree required.
• 5+ years of direct clinical patient care experience post residency or fellowship.
• Current and ongoing ABMS Board Certification.
• Active medical license in at least one jurisdiction.
• No sanctions from Federal or State authorities; able to credential.
• Excellent verbal and written communication skills.
• Experience in quality management, utilization management, discharge planning, or post-acute services.

Aufgaben

• Provide medical interpretation and determinations of service appropriateness.
• Collaborate with team members and Lead Medical Director; operate with minimal direction after mentoring.
• Support market-wide objectives and community relations as directed.

Kenntnisse

MD/DO

Clinical experience

Board Certification

Medical license

Credentialing

Communication

Analytical skills

Ausbildung

MD/DO degree

Jobbeschreibung

Humana Inc. is seeking a Medical Director to review inpatient and post-acute care requests, determine eligibility, and ensure alignment with national guidelines and CMS requirements.

The role emphasizes collaboration with teams, ongoing credentialing, and clinical documentation oversight. The position supports Medicare/Medicaid/Medicare Advantage programs, offers a compensation range of $223,800 to $313,100 per year, and a bonus incentive plan.