OneHome - Medical Director - Part Time

The Medical Director will review home health, SNF, DME, and dual Medicare/Medicaid waiver requests, providing medical interpretations and determinations based on CMS Medicare Guidance, national guidelines, Humana policies, and clinical standards. They will make decisions about the appropriateness of services provided by other healthcare professionals, ensuring compliance with review policies and procedures. Responsibilities include learning and operationalizing Medicare and Medicare Advantage requirements, participating in educational activities, creating content for teaching, and conducting clinical case reviews for the Medicare population. The Medical Director will also identify medical management operational improvements, participate in call rotations (potentially including weekends), develop collaborative relationships with teams and partners, and support Home Solutions as needed.