- MD or DO degree
- 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).
- Current and ongoing Board Certification an approved ABMS Medical Specialty
- A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.
- No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
- Excellent verbal and written communication skills .
- Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.
- Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
- Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.
- Experience with national guidelines such as MCG or InterQual
- Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists
- Exposure to Public Health, Population Health, analytics, and use of business metrics.
- Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health.
- The curiosity to learn and the flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals.
- Ability to thrive in a dynamic fast-paced, team-oriented environment.
- Commitment to a culture of innovation, including being facile with using technology to improve workflows
- Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution
- Passionate about contributing to an organization's focus on consistency in outcomes, consumer experiences and a highly engaged team culture
- Identify medical management operational improvements, including those within the medical director area
- Participate in call rotation
- Develop collaborative relationships with Team and key partners within the Medicare Line of Business.
-
Medical Director
2 weeks ago
Peak Recruiter, Sanford Rose and Associates Oklahoma City, United StatesCompany Description · Valir Health is a comprehensive healthcare organization based in Oklahoma City, OK. Our services include a physical rehabilitation hospital, physical therapy clinics, a hospice division, PACE (Program of All-inclusive Care for the Elderly), corporate health ...
-
Medical Director
3 weeks ago
Potomac Healthcare Solutions Oklahoma City, United StatesPhysician Director · Kay County, OK · Position Duties and Responsibilities: · Serves as medical director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site. · Manage day to day medical operatio ...
-
Medical Director
5 days ago
OptimumCare Corporation Oklahoma City, United StatesJob Description · Job Description · We are seeking a Medical Director / Hospitalist to join our team · Job Duties · Deliver high-quality medical care to hospitalized patients, conducting initial assessments, daily rounds, and ongoing management. · Perform thorough physical exa ...
-
Medical Director
1 week ago
Primary Care Solutions Oklahoma City, United StatesPrimary Care Solutions provides industry-leading Primary Care services to Veterans. Veteran-led and clinician-managed, we deliver compassionate, expert medical care, establishing personal bonds with our Veterans in our Community-Based Outpatient Clinics (CBOCs). We have consisten ...
-
Medical Director
4 days ago
Optimum Care Oklahoma City, United StatesJob Description · Job DescriptionWe are seeking a Medical Director / Hospitalist to join our team · Job Duties · Deliver high-quality medical care to hospitalized patients, conducting initial assessments, daily rounds, and ongoing management. · Perform thorough physical examinati ...
-
Senior Medical Director
1 week ago
Oak Street Health Oklahoma City, United StatesDescription · Company: Oak Street Health · Title: Senior Medical Director · Location: Various · Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages ...
-
Hospitalist Medical Director
2 weeks ago
StaffMed Health Partners Oklahoma City, United StatesStaffMED Health Partners is collaborating to fill a Hospitalist Medical Director role with a leading Hospitalist Group in Oklahoma City, that strives to become an innovative healthcare service provider for its patients through excellent healthcare services to transform the lives ...
-
PACE Medical Director
5 days ago
Peak Recruiter Oklahoma City, United StatesAt Valir PACE, we are in the business of revolutionizing senior care with a commitment to innovation and delivering a higher standard of care. We are seeking a visionary and dynamic Medical Director to lead our clinical services for our Program of All-Inclusive Care for the Elder ...
-
Associate Medical Director
6 days ago
University of Massachusetts Medical School Oklahoma City, United StatesExplore the Possibilitiesand Advance with Us. · You can view all open jobs by clicking here · or use the following search form to find jobs that suit your specificcareer interests. · Associate Medical Director- - Office of Clinical Affairs · Associate Medical Director- - Office ...
-
Senior Medical Director
1 week ago
Oak Street Health Inc. Oklahoma City, United StatesCompany: Oak Street Health · Title: Senior Medical Director · Location: Various · Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and ...
-
Senior Medical Director
1 week ago
LeadingAge Oklahoma City, United StatesPosition Overview: The Medical Director/Senior Medical Director in Clinical Development at Bicara Therapeutics will play a pivotal role as the Clinical Lead for multiple oncology clinical trials. This individual will collaborate with cross-functional, multidisciplinary teams to s ...
-
REQUISITION× Medical Director
3 days ago
Charles River Community Health Oklahoma City, United StatesMedical Director - Physician Assistant (PA) · CLASSIFICATION/STATUS: · Exempt, Full Time, Permanent · IMMEDIATE SUPERVISOR : Chief Clinical Officer · SUPERVISORY RESPONSIBILITIES : Associate Medical Directors · PAY RANGE : · Band 10: · ($165,000 - $195,000/year) · WHO YOU ARE ...
-
PACE Medical Director
1 week ago
Peak Recruiter Oklahoma City, United StatesAt Valir PACE, we are in the business of revolutionizing senior care with a commitment to innovation and delivering a higher standard of care. We are seeking a visionary and dynamic Medical Director to lead our clinical services for our Program of All-Inclusive Care for the Elder ...
-
Clinical Medical Director
3 weeks ago
Korzen Health Oklahoma City, United StatesJob Description · Job DescriptionKorzen Health is working with Healogics and Integris Baptist Health Medical Center to employ a Wound Care Physician. · We offer Wound Care and Hyperbaric Oxygen (HBO) Therapy training. You will have a full-team in place from the initial start date ...
-
PACE Medical Director
4 days ago
Valir Health Oklahoma City, United StatesJob Description · Job DescriptionDuties/Responsibilities: · Ensure the highest standard of patient care by establishing and maintaining clinical protocols, guidelines, and quality assurance measures. · Collaborate with interdisciplinary teams to optimize the health and well-being ...
-
Medical Director
3 weeks ago
McKesson Oklahoma City, United StatesMcKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you a ...
-
Medical Director, Clinical Development
1 week ago
Nimbus Therapeutics Oklahoma City, United StatesMedical Director, Clinical Development (Oncology) · Nimbus has an outstanding opportunity for an Medical Director, Clinical Development to join our team. This person will serve as the primary Medical Monitor on a first-in-human study, establishing all the relevant relationships ...
-
Physician Center Medical Director
1 week ago
Concentra Oklahoma City, United StatesOverview · BONUS and Paid Loan Reimbursement · More time for your patients and more time for you. It's time to learn more about careers at Concentra. Monday through Friday 8AM - 5PM, no call and no weekends~ · At Concentra, our physicians spend 90% of their time clinically treati ...
-
Physician Center Medical Director
2 weeks ago
Concentra Oklahoma City, United States PermanentOverview · BONUS and Paid Loan Reimbursement · More time for your patients and more time for you. It's time to learn more about careers at Concentra. Monday through Friday 8AM - 5PM, no call and no weekends~ · At Concentra, our physicians spend 90% of their time clinically treati ...
-
Medical Director Physician Opportunity
5 days ago
INTEGRIS Health Oklahoma City, United StatesHeart Failure, Heart Transplant and MCS in Oklahoma City, Oklahoma · About the Opportunity · INTEGRIS Health Heart Hospital is recruiting a Full-time, BC Physician - Director of Advanced Cardiopulmonary Care. The successful candidate will join a highly skilled multidisciplinary ...
Medical Director - Oklahoma City, United States - Humana
![Humana background](https://contents.bebee.com/companies/us/humana/background-wFKwp.png)
Description
Become a part of our caring community and help us put health first
The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work.
The Medical Director's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors are expected to understand Humana processes with a focus on collaborative business relationships. The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enjoy working in a team-based environment. Medical Directors support Humana value throughout all activities.
Responsibilities
The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines.
Use your skills to make an impact
Required Qualifications
Preferred Qualifications
Additional Information
Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.
#physiciancareers
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$199,400 - $274,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our