Company name
Humana Inc.
Location
Albany, NY, United States
Employment Type
Full-Time
Industry
Healthcare, Manager
Posted on
Oct 21, 2022
Profile
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 Qualifications
MD or DO degree
5 years of direct patient care 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
Board Certified in an approved ABMS Medical Specialty
Excellent communication skills
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
Experience with Medical management organizations, hospitals and 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
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 and/or condition committees. Typically reports to a Lead or Regional or Corporate Medical Director, depending on size of region/line of business.
#physiciancareers
Scheduled Weekly Hours
40
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Company info
Humana Inc.
Website : http://www.humana.com