[Remote] Medical Director - Acute Rehab Team at Humana

The Medical Director will use their medical background and judgment to determine if requested services, level of care, and site of service are authorized, adhering to regulatory compliance, national clinical guidelines, CMS policies, and internal standards. This role involves computer-based review of clinical scenarios, primarily from post-acute care environments, reviewing submitted clinical records, prioritizing daily work, and communicating decisions to internal associates. Responsibilities include discussing clinical scenarios with external physicians via phone to gather information or discuss determinations, potentially involving conflict resolution. The Medical Director will provide medical interpretation and determinations on acute inpatient rehabilitation authorization requests, supporting and collaborating with team members and other departments. Daily work will be performed with minimal direction after structured training, with an expectation for consistency in thinking and authorship, and independence in meeting enterprise expectations and compliance timelines. The role may also involve grievance and appeals reviews.