Medical Director - Onehome

HumanPanorama

Base: $223,800 - $313,100 py; bonus: eligible for ...
Hybrid
Review clinical cases for medical necessity
Apply cms medicare and medicaid guidelines
Ensure regulatory compliance with federal laws
Humana's Onehome is seeking a Medical Director to oversee healthcare services compliance with national guidelines and CMS policies, focusing on Medicare and Medicaid members. The role requires a medical degree, board certification, and extensive clinical experience, emphasizing regulatory compliance and collaborative team culture

Job Summary

  • The Medical Director relies on fundamentals of CMS Medicare Guidance to review and determine whether healthcare services align with national guidelines and Humana policies.
  • This role requires interpreting clinical guidelines and applying them consistently to ensure decisions comply with all federal and state 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

Humana's Onehome is seeking a Medical Director to oversee healthcare services compliance with national guidelines and CMS policies, focusing on Medicare and Medicaid members. The role requires a medical degree, board certification, and extensive clinical experience, emphasizing regulatory compliance and collaborative team culture.

Salary

Base: $223,800 - $313,100 per year; Bonus: Eligible for incentive plan based on company/individual performance; Benefits: Medical, dental, vision, 401(k), paid time off included

Skills & Requirements

Must-have

  • Review clinical cases for medical necessity
  • Apply CMS Medicare and Medicaid guidelines
  • Ensure regulatory compliance with federal laws
  • Participate in call rotations including weekends
  • Maintain active state medical license

Nice-to-have

  • Experience with inpatient care environments
  • Knowledge of NCD/LCD and MCG guidelines
  • Background in Geriatrics or Internal Medicine
  • Ability to adapt to new technologies
  • Collaborative team culture contribution

Key Requirements

  • MD or DO degree required
  • Current 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

Work Rights

Not specified

Tailored Resume

Cover Letter