Medical Director - Care Plus - Florida

The Medical Director provides medical interpretation and determinations regarding services provided by healthcare professionals, ensuring alignment with national guidelines, CMS requirements, Humana policies, clinical standards, and contracts. They actively use their medical background and experience to make determinations about authorized services and care levels, review clinical records, prioritize daily work, communicate decisions to associates, and participate in care management. The Medical Director also engages in discussions with external physicians, supports regional market priorities through collaboration with business relationships, and may oversee coding practices, clinical documentation, grievance processes, and outpatient services. They provide medical interpretation and support team members, departments, and the Regional VP Health Services, exercising independence and meeting compliance timelines.