Medical Director - Annapolis - Humana

    Humana
    Humana Annapolis

    1 day ago

    Humana background
    Description

    Medical Director - Northeast Region

    An exciting opportunity to join our team and help shape the future of healthcare.

    The Medical Director plays a key role in ensuring that members receive high-quality, cost-effective care. They will work closely with cross-functional teams to develop and implement clinical programs, policies, and procedures that align with Humana's strategic objectives.

    Key Responsibilities:

    • Provide medical interpretation and determinations regarding services provided by other healthcare professionals
    • Support and collaborate with other team members, departments, and stakeholders to achieve business objectives
    • Stay up-to-date on national guidelines, CMS requirements, and Humana policies to inform decision-making
    • Exercise independence in meeting departmental expectations and meet compliance timelines

    Requirements:

    • MD or DO degree
    • 5+ years of direct clinical patient care experience post-residency or fellowship
    • Board Certified in an approved ABMS Medical Specialty
    • A current and unrestricted license in at least one jurisdiction
    • No current sanction from Federal or State Governmental organizations

    Preferred Qualifications:

    • Knowledge of the managed care industry, including Medicare Advantage and Medicaid
    • Utilization management experience in a medical management review organization
    • Experience with national guidelines such as MCG or InterQual
    • Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialization

    About Us:

    Humana Inc. is a leading health and well-being company that puts health first – for our teammates, customers, and communities. We make it easier for millions of people to achieve their best health, delivering care and service when they need it most.

    We are committed to diversity, equity, and inclusion and welcome applications from candidates who share our values.



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