Associate Medical Director / Medical Director, Clinical Development
TempusFull Time
Junior (1 to 2 years)
Candidates must possess an MD or DO degree with current and ongoing board certification in an approved ABMS Medical Specialty. A current and unrestricted medical license in at least one jurisdiction is required, with willingness to obtain licenses in other states as needed. The role demands a minimum of 5 years of direct clinical patient care experience post-residency or fellowship and requires no sanctions from Federal or State Governmental organizations. Applicants must be able to pass credentialing requirements and demonstrate excellent verbal and written communication skills, along with strong analytic and interpretive abilities. Preferred qualifications include experience in an inpatient setting or with the Medicare population, knowledge of national guidelines like NCD/LCD, MCG®, or InterQual, and the ability to thrive in a fast-paced, dynamic environment.
The Medical Director will review home health, SNF, DME, and dual Medicare/Medicaid requests based on CMS Medicare Guidance. They will provide medical interpretation and determine if services align with national guidelines, CMS requirements, Humana policies, clinical standards, and contracts. Responsibilities include conducting clinical case reviews for Medicare members, reporting to the Lead Medical Director, and identifying operational improvements within medical management. The role also involves participating in call rotations, potentially including weekend coverage, developing collaborative relationships with teams and partners, and supporting Home Solutions as needed. Additionally, the Medical Director will create content for and participate in educational activities and may travel occasionally for training or meetings.
Health insurance provider for seniors and military
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.