Remote Medical Director - Medicare & Medicaid Compliance

Humana, Inc.; Madison (WI); Remoto; USD 224.000 - 313.000; Tempo pieno

Vantaggi offerti da questo lavoro

Bonus incentive plan

Remote work option

Descrizione del lavoro

Humana, Inc. seeks a Medical Director to oversee CMS Medicare guidance for Home Health, SNF, DME, and dual Medicare/Medicaid requests. The position evaluates medical necessity and ensures alignment with CMS policies, clinical standards, and Humana contracts.

The role requires board-certified MD/DO, state licensure, and credentialing, with remote work options and occasional travel. The incumbent will review clinical cases and lead regulatory compliance initiatives, collaborating across teams to

Competenze

• MD or DO degree is required.
• Current, active board certification from ABMS/AOABPS is required.
• Unrestricted state medical license in at least one state; willingness to obtain others.

Mansioni

• Review clinical cases and determine medical necessity for Medicare and Medicaid members.
• Ensure compliance with review policies, procedures, and regulatory standards.
• Apply clinical guidelines, CMS policies, and Medicare/Medicaid requirements.
• Identify opportunities for medical management operational 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.
• Support Home Solutions and other activities as assigned by leadership.

Conoscenze

ABMS/AOABPS board certification

State medical license

Credentialing

MS Office proficiency

Communication skills

Clinical experience post residency

Formazione

MD/DO degree

Descrizione del lavoro

Humana, Inc. seeks a Medical Director to oversee CMS Medicare guidance for Home Health, SNF, DME, and dual Medicare/Medicaid requests. The position evaluates medical necessity and ensures alignment with CMS policies, clinical standards, and Humana contracts.

The role requires board-certified MD/DO, state licensure, and credentialing, with remote work options and occasional travel. The incumbent will review clinical cases and lead regulatory compliance initiatives, collaborating across teams to