Medical Director of Payment Integrity - Trenton - Humana

    Humana
    Humana Trenton

    6 days ago

    Description

    Job Summary

    The Medical Director plays a critical role in evaluating and authorizing healthcare services while ensuring compliance with regulations.

    • Determine whether healthcare services align with national guidelines (CMS requirements) and Humana standards through thorough reviews of complex clinical scenarios using computer systems.

    Your role involves managing daily priorities by analyzing submitted clinical records,
    communicating decisions to internal teams,
    collaborating with various professionals,
    departments, and colleagues under mentorship. (Following training), individuals will work autonomously within a clearly defined structure adhering to departmental goals & compliance timelines.


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