Medical Director - Southeast Region

The Medical Director will review health claims and use their medical background to determine authorization for requested services, level of care, and site of service based on national clinical guidelines, CMS policies, and internal standards. Responsibilities include computer-based review of clinical scenarios, prioritizing daily work, communicating decisions, and potentially participating in care management. The role involves discussions with external physicians, which may require conflict resolution, and may include an overview of coding practices, documentation, grievance and appeals processes, and outpatient services. Additionally, the Medical Director will support regional market priorities, collaborate with team members and other departments, and uphold Humana values and mission.