Remote Medical Director (Medicare/Medicaid)

Humana; Olympia (WA); Remoto; USD 224.000 - 313.000; Tempo pieno

Vantaggi offerti da questo lavoro

Work from home

Descrizione del lavoro

Humana, Inc. seeks a Medical Director to oversee medical necessity reviews for Medicare/Medicaid members, ensuring alignment with CMS guidance and Humana policies.

The role emphasizes regulatory compliance, collaboration, and education to support patient care across home health and related services. Responsibilities include reviewing cases, applying clinical guidelines, and participating in after-hours call rotations.

Competenze

• MD or DO degree required.
• Active board certification from ABMS/AOABPS; NB PAs not accepted.
• Current and unrestricted state medical license; willingness to obtain others as required.

Mansioni

• Review medical necessity of services for Medicare/Medicaid members.
• Ensure compliance with policies and regulatory standards.
• Apply CMS policies, Medicare/Medi- care requirements.
• Identify opportunities for medical management improvements.
• Participate in call rotations, including weekend and after-hours work.
• Contribute to a collaborative team culture and exceptional consumer experiences.
• Engage in educational activities and content creation.
• Support Home Solutions and other activities as assigned.

Conoscenze

Communication

Microsoft Office

Data interpretation

Adaptable to new technologies

Formazione

MD or DO degree

ABMS/AOABPS board certification

State medical license

Descrizione del lavoro

Humana, Inc. seeks a Medical Director to oversee medical necessity reviews for Medicare/Medicaid members, ensuring alignment with CMS guidance and Humana policies.

The role emphasizes regulatory compliance, collaboration, and education to support patient care across home health and related services. Responsibilities include reviewing cases, applying clinical guidelines, and participating in after-hours call rotations.