Remote Medical Director, Medicare Utilization

Humana, Inc.; Richmond (VA); Remoto; USD 224.000 - 313.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical benefits

Dental benefits

Vision benefits

401(k) retirement savings plan

Paid time off

Descrizione del lavoro

Humana, Inc. is seeking a Medical Director to review preauthorization requests and determine appropriate level of care and site of service. The role emphasizes adherence to national guidelines, CMS requirements, and Humana policies within a regulated environment.

The position involves remote work, occasional travel to Humana offices for training or meetings, and collaboration with regional leaders. Strong medical judgment, communication, and analytical skills are essential.

Competenze

• MD or DO degree and board certification required.
• Active medical license in at least one state; willingness to obtain others.
• Excellent verbal and written communication skills.

Mansioni

• Provide medical interpretation and determinations against national guidelines, CMS requirements, Humana policies and clinical standards.
• Collaborate with Humana colleagues, Regional VP Health Services, and other teams to ensure compliant decisions.
• Manage Utilization Management for the care received by members in a defined market or population.
• Engage in grievance and appeals reviews when applicable and participate in project teams or committees.
• Communicate decisions clearly to internal associates and maintain timely documentation.

Conoscenze

MD/DO

Board Certification

Medical License

Communication skills

Analytic skills

Curiosity & adaptability

Formazione

MD or DO degree

Descrizione del lavoro

Humana, Inc. is seeking a Medical Director to review preauthorization requests and determine appropriate level of care and site of service. The role emphasizes adherence to national guidelines, CMS requirements, and Humana policies within a regulated environment.

The position involves remote work, occasional travel to Humana offices for training or meetings, and collaboration with regional leaders. Strong medical judgment, communication, and analytical skills are essential.