Remote Medical Director: Medicare & Medicaid Compliance

Humana; Austin (TX); Remoto; USD 224.000 - 313.000; Tempo pieno

Vantaggi offerti da questo lavoro

Remote work at home

Bonus incentive plan

Descrizione del lavoro

Humana, Inc. is seeking a Medical Director to oversee the medical necessity determinations for Medicare/Medicaid services across Home Health, SNF, and DME programs. The role emphasizes regulatory compliance, policy alignment, and clinical standards within Humana's framework.

The position requires board certification, an active medical license, and at least five years of direct patient care, with remote work and a 40-hour week. Occasional travel may be needed.

Competenze

• MD or DO degree.
• Active board certification by ABMS/AOABPS; NBPA S certification not accepted.
• Current and unrestricted state medical license; willingness to obtain others as needed.

Mansioni

• Review clinical cases to determine medical necessity for Medicare/Medicaid members.
• Ensure compliance with policies, procedures and regulatory standards.
• Apply CMS policies and Medicare/Medicaid requirements.
• Identify opportunities for medical management improvements.
• Participate in call rotations, including weekends and after-hours.

Conoscenze

Verbal and written communication

Microsoft Office

Data interpretation

Adaptability to new technology

Formazione

MD or DO degree

ABMS/AOABPS board certification

State medical license

Descrizione del lavoro

Humana, Inc. is seeking a Medical Director to oversee the medical necessity determinations for Medicare/Medicaid services across Home Health, SNF, and DME programs. The role emphasizes regulatory compliance, policy alignment, and clinical standards within Humana's framework.

The position requires board certification, an active medical license, and at least five years of direct patient care, with remote work and a 40-hour week. Occasional travel may be needed.