Medical Director - Spine
CVS Health174,070 - 374,920 USD/year
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates must hold an MD or DO degree, possess a current and unrestricted license in at least one state, and be willing to obtain the necessary licenses for various states within the assigned region. Board certification in an approved ABMS Medical Specialty, such as Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, Physical Medicine and Rehab, Anesthesiology, or General Surgery, is required, along with five years of established, post-residency clinical experience. Strong knowledge of the managed care industry, including Medicare, Medicaid, and commercial products, is also necessary.
Responsibilities
The Medical Director will review health claims and preservice appeals, providing medical interpretation and decisions regarding the appropriateness and medical necessity of services. They will represent Humana at Administrative Law Judge hearings, exercise independent clinical judgment on complex issues, assist the medical director team and leaders in meeting enterprise-wide business needs, and develop HR policies to ensure compliance with coverage policies and performance standards.
Skills
Medical License
Board Certification
Clinical Judgment
Health Claims Review
Appeals Process
Medicare/Medicaid/Commercial Knowledge
Regulatory Compliance
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