Remote Medical Director – Medicare & Compliance

Humana, Inc.; Salem (OR); Remoto; USD 224.000 - 313.000; Tempo pieno

Vantaggi offerti da questo lavoro

Remote work at home

40-hour work week

Descrizione del lavoro

Humana, Inc. seeks a Medical Director to review and determine medical necessity for Medicare/Medicaid services, aligning with CMS guidance, Humana policies, and clinical standards. The role requires strong regulatory interpretation and ongoing credentialing, with work conducted under OneHome governance.

Responsibilities include evaluating services, ensuring compliance, and contributing to an engaged team culture. Remote work is available with defined hours and travel as needed.

Competenze

• MD or DO degree required.
• Board certification by ABMS or AOABPS required; NBPS certification not accepted.
• Current and unrestricted state medical license in at least one state; willingness to obtain others as region requires.

Mansioni

• Review medical necessity of services for Medicare/Medicaid members.
• Ensure compliance with review policies and regulatory standards.
• Apply CMS policies and Medicare/Medicaid requirements.
• Identify opportunities for medical management operational improvements.
• Participate in call rotations (weekends and after-hours).
• Support Home Solutions and other activities as assigned by OneHome leadership.

Conoscenze

Verbal and written communication

Data interpretation

Adaptability to new technologies

Formazione

MD or DO degree

Board certification ABMS/AOABPS

State medical license in at least one state

Strumenti

Microsoft Office

Descrizione del lavoro

Humana, Inc. seeks a Medical Director to review and determine medical necessity for Medicare/Medicaid services, aligning with CMS guidance, Humana policies, and clinical standards. The role requires strong regulatory interpretation and ongoing credentialing, with work conducted under OneHome governance.

Responsibilities include evaluating services, ensuring compliance, and contributing to an engaged team culture. Remote work is available with defined hours and travel as needed.