Base: $223,800 - $313,100 py; bonus: eligible for ...
Hybrid
Review clinical cases for medical necessity
Apply cms guidelines and medicare requirements
Ensure regulatory compliance with federal laws
CarePlus Health Plans Inc. is seeking a Medical Director for their OneHome division. The ideal candidate will have extensive experience in clinical patient care and must ensure compliance with healthcare guidelines for Medicare and Medicaid services
Job Summary
The Medical Director reviews and determines whether healthcare services align with national guidelines, CMS requirements, and Humana policies.
This role requires interpreting clinical guidelines and applying them consistently to ensure decisions comply with all regulatory standards.
Humana offers competitive benefits including medical, dental, vision, 401(k) retirement savings, and paid time off to support whole-person well-being.
Matching Summary
Match Score: 85
CarePlus Health Plans Inc. is seeking a Medical Director for their OneHome division. The ideal candidate will have extensive experience in clinical patient care and must ensure compliance with healthcare guidelines for Medicare and Medicaid services.
Salary
Base: $223,800 - $313,100 per year; Bonus: Eligible for incentive plan based on performance; Benefits: Medical, dental, vision, 401(k), paid time off
Skills & Requirements
Must-have
Review clinical cases for medical necessity
Apply CMS guidelines and Medicare requirements
Ensure regulatory compliance with federal laws
Participate in call rotations including weekends
Interpret national clinical guidelines effectively
Nice-to-have
Experience in inpatient or geriatric care environments
Knowledge of NCD/LCD, MCG, or InterQual guidelines
Ability to drive operational improvements
Strong collaborative team culture contribution
Willingness to learn new workflow technologies
Key Requirements
MD or DO degree required
Current active board certification from ABMS or AOABPS
Unrestricted state medical license in at least one state
10 years of direct clinical patient care experience post-residency
No sanctions from Federal or State Governmental organizations