Medical Director - Pacific Region

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 clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).

Current and ongoing Board Certification an approved ABMS Medical Specialty

A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.

No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.

Excellent verbal and written communication skills .

Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.

Preferred Qualifications

Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.

Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.

Experience with national guidelines such as MCG® or InterQual

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

Advanced degree such as an MBA, MHA, MPH

Exposure to Public Health, Population Health, analytics, and use of business metrics.

Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health.

The curiosity to learn, the flexibility to adapt and the courage to innovate

Additional Information

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. May participate on project teams or organizational committees.

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

#physiciancareers

Scheduled Weekly Hours

40

Colorado Pay Range

The compensation range represents a good-faith estimate of annualized starting pay at the time of posting based on a full-time 40-hour workweek and may vary based on geographic location and/or employment type. Individual pay decisions will vary based on demonstrated job-related skills such as education, experience, certifications, etc.

$194,500 - $267,625

Pay Type

Salary

Incentive

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

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