Humana
Tampa , FL 33601
Full-time, Part-time
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Job Description
Description
The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Responsibilities
Job Title: Medical Director - Medicaid
Location: Work from Home in Florida
Job Description
The Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
Required Qualifications
•5+ years of clinical experience
•A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for the state of Florida
•MD or DO degree
•Board Certified in an approved ABMS Medical Specialty
•Excellent communication skills with 5 years of established clinical experience
•Knowledge of the managed care industry including Medicare or Medicaid products
•Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
Preferred Qualifications
•Medical management organizations, hospitals and experience, working with health insurance other healthcare providers.
•Internal Medicine, Family Practice, Geriatrics, Hospitalist clinical specialists.
•Previous Medicare, Medicaid, and/or Commercial experience.
•LTC experience preferred
Additional Information
•The Medical Director conducts clinical reviews of the care received by members in an assigned market, member population, or condition type. May also engage in appeals reviews and/or condition committees. Must hold a MD or DO and be board certified and typically reports to a Lead or Regional or Corporate Medical Director, depending on size of region/line of business.
#physiciancareers
Scheduled Weekly Hours
40
Posted 3 Days Ago
About Us
About Us
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms -when and where they need it. Our employees are at the heart of making this happen and that's why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
Equal Opportunity Employer
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