Medical Director - Florida

4 days ago

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Humana

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10,000+

Description

• The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts • Supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services • Conducts Utilization Management of the care received by members in an assigned market, member population, or condition type • Engages in grievance and appeals reviews

Requirements

• 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.

Benefits

• 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 • Many other opportunities