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  • Medical Director - Annapolis - Humana

    Humana
    Humana Annapolis

    4 weeks ago

    Humana background
    Description

    Medical Director

    Put Health First with Humana

    We are seeking a Medical Director to lead our medical review team and ensure high-quality care for our members.

    The Medical Director will rely on their medical background and experience to review health claims, authorize services, and make determinations on the level of care and site of service. They will work closely with diverse resources, including national clinical guidelines, CMS policies, and internal teaching conferences.

    The ideal candidate will have a strong analytical and interpretation skillset, with prior experience in teams focusing on quality management, utilization management, case management, and discharge planning. They should also be knowledgeable about managed care industry principles and Medicare Advantage requirements.

    Responsibilities:

    • Provide medical interpretation and determinations on health claims
    • Collaborate with other departments and team members to support member care
    • Participate in project teams and organizational committees as needed

    Requirements:

    • MD or DO degree
    • 5+ years of direct clinical patient care experience
    • Current and ongoing Board Certification in an approved ABMS Medical Specialty
    • A current and unrestricted license in at least one jurisdiction

    Preferred Qualifications:

    • Knowledge of managed care industry principles
    • Utilization management experience
    • Experience with national guidelines and coding practices
    • Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists

    At Humana, we offer competitive benefits, a structured environment, and opportunities for growth and development. If you are passionate about putting health first and making a meaningful impact, apply now!

    Work Schedule: Monday - Friday, with some weekends required.


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