Remote Medical Director – Medicare/Medicaid Compliance

Humana, Inc.; Lansing (MI); Remoto; USD 224.000 - 313.000; Tempo pieno

Descrizione del lavoro

Humana, Inc. is seeking a Medical Director to oversee Medicare/Medicaid services for Home Health, SNF, DME and related programs. You will review medical necessity, ensure regulatory compliance, and apply CMS guidelines across multiple states within the OneHome framework.

The role requires board-certified physicians with active state licenses, leadership in clinical settings, and the ability to work in a remote, home-based arrangement with regular hours and occasional travel for training.

Competenze

• MD or DO degree with active license and board certification.
• Five years of direct clinical patient care post residency/fellowship.
• Ability to pass credentialing requirements.
• Strong analytical and data interpretation skills.

Mansioni

• Review clinical cases and determine medical necessity for Medicare/Medicaid members.
• Ensure compliance with review policies, procedures, and regulatory standards.
• Apply CMS policies and Medicare/Medicaid requirements.
• Identify opportunities for medical management improvements.
• Participate in call rotations, including weekend coverage and after-hours coverage.
• Contribute to an engaged, collaborative team culture that supports organizational excellence.
• Deliver exceptional consumer experiences.
• Participate in educational activities by attending required conferences and creating content to present for individual subject matter contribution.
• Support Home Solutions and other activities as assigned by the OneHome leadership.

Conoscenze

Strong verbal and written comms

Microsoft Office proficiency

Adaptable learner of new tech

Formazione

MD or DO degree

Descrizione del lavoro

Humana, Inc. is seeking a Medical Director to oversee Medicare/Medicaid services for Home Health, SNF, DME and related programs. You will review medical necessity, ensure regulatory compliance, and apply CMS guidelines across multiple states within the OneHome framework.

The role requires board-certified physicians with active state licenses, leadership in clinical settings, and the ability to work in a remote, home-based arrangement with regular hours and occasional travel for training.