Medical Director - Spine
CVS Health174,070 - 374,920 USD/year
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates must possess a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree, hold a current and unrestricted medical license in at least one jurisdiction, and be willing to obtain licenses as required for various states within the assigned region. Board certification in an approved ABMS Medical Specialty is required, along with excellent communication skills and a minimum of five years of established clinical experience. Knowledge of the managed care industry, including Medicare, Medicaid, and commercial products, is also necessary.
Responsibilities
The Corporate Medical Director will provide medical interpretation and decisions regarding the appropriateness of services provided by other healthcare professionals, ensuring compliance with review policies, procedures, and performance standards. They will monitor and review health claims and preservice appeals, represent Humana at Administrative Law Judge hearings, and exercise independent judgment on complex issues related to job duties. Additionally, the Medical Director will utilize independent judgment to analyze variable factors and determine the best course of action, and may require occasional travel to Humana offices for training or meetings.
Skills
Medical interpretation
Healthcare decision-making
Claims review
Appeals process
Legal representation
Independent judgment
Communication skills
Knowledge of Medicare, Medicaid, Commercial insurance
Humana
Health insurance provider for seniors and military
About Humana
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.
Key Metrics
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees