Medical Director - Claims

HumanPanorama

Base: $223,800 - $313,100 py; bonus: eligible for ...
Hybrid
Md or do degree required
5+ years direct clinical patient care experience
Current board certification in abms or aoa specialty
The Medical Director makes critical determinations regarding service authorization and level of care based on national clinical guidelines and CMS requirements

Job Summary

  • The Medical Director makes critical determinations regarding service authorization and level of care based on national clinical guidelines and CMS requirements.
  • This role involves reviewing moderately complex to complex clinical scenarios from inpatient, outpatient, and post-acute care environments while ensuring regulatory compliance.
  • Humana offers competitive benefits including medical, dental, vision, 401(k) retirement savings, and paid time off to support whole-person well-being.

Matching Summary

The Medical Director makes critical determinations regarding service authorization and level of care based on national clinical guidelines and CMS requirements.

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

  • MD or DO degree required
  • 5+ years direct clinical patient care experience
  • Current board certification in ABMS or AOA specialty
  • Experience with Medicare Advantage and Managed Medicaid
  • Utilization management review organization experience

Nice-to-have

  • Advanced degrees such as MBA, MHA, or MPH
  • Exposure to public health and population health analytics
  • Familiarity with social determinants of health
  • Experience working with case managers on complex cases
  • Knowledge of MCG or InterQual guidelines

Key Requirements

  • MD or DO degree
  • 5+ years clinical experience post-residency
  • Board Certification (ABMS/AOA)
  • Unrestricted medical license
  • No federal or state sanctions

Work Rights

Not specified

Tailored Resume

Cover Letter