Medical Director - S. Florida

Profile

Job Information

Humana

Medical Director - S. Florida

in

Green Bay

Wisconsin

Description

The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required

5 years of clinical experience

A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment

MD or DO degree

Board Certified in an approved ABMS Medical Specialty

Excellent communication skills with 5 years of established clinical experience

Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products

Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab

Preferred Qualifications

Medical management organizations, hospitals and experience, working with health insurance other healthcare providers, patient interaction, etc.

Internal Medicine, Family Practice, Geriatrics, Hospitalist clinical specialists.

Previous Medicare, Medicaid, and/or Commercial experience.

Additional Information

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

Provide proof of full vaccination or commit to testing protocols

*OR  *

Provide proof of applicable exemption including any required supporting documentation

​​Medical, religious, state and remote-only work exemptions are available.

Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for several months after training, until positions become available for specific markets. May participate on project teams or organizational committees.

#physiciancareers

The Medical Director conducts clinical reviews of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews and/or condition committees. Must hold a MD or DO and be board certified and typically reports to a Lead or Regional or Corporate Medical Director, depending on size of region/line of business. No direct supervisory responsibility is expected though it may occur or the Medical

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com