[Remote] Medical Director-Payment Integrity at Humana

The Medical Director will utilize their medical background to determine authorization for requested services, level of care, and site of service, primarily within inpatient or post-acute care settings. This role involves computer-based review of clinical scenarios, evaluation of submitted clinical records, prioritization of daily tasks, and communication of decisions. The Medical Director will learn and apply Medicare, Medicaid, and Medicare Advantage requirements, and may be involved in providing medical interpretation for services based on national guidelines, CMS requirements, and Humana policies. Responsibilities also include supporting team members, collaborating with other departments, and working with minimal direction after completing training, while meeting compliance timelines and departmental expectations.