Medical Director National Op Medicare

HumanPanorama

Base: $223,800 - $313,100 py; bonus: eligible for ...
Hybrid
Md or do degree required
5+ years direct clinical experience
Current board certification abms or aoa
The Medical Director provides critical medical interpretation and determinations ensuring services align with national guidelines, CMS requirements, and Humana policies

Job Summary

  • The Medical Director provides critical medical interpretation and determinations ensuring services align with national guidelines, CMS requirements, and Humana policies.
  • This role involves reviewing moderately complex to complex clinical scenarios from inpatient and post-acute environments to authorize or deny requested levels of care.
  • 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 provides critical medical interpretation and determinations ensuring services align with national guidelines, CMS requirements, and Humana policies.

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, disability, life insurance

Skills & Requirements

Must-have

  • MD or DO degree required
  • 5+ years direct clinical experience
  • Current board certification ABMS or AOA
  • Unrestricted medical license in one jurisdiction
  • Utilization management review skills
  • CMS policy and national guideline knowledge

Nice-to-have

  • Oncology or genetics specialty training
  • Experience with MCG or InterQual guidelines
  • Knowledge of value-based care models
  • Advanced degree in business or public health
  • Strong conflict resolution abilities
  • Collaborative relationship building skills

Key Requirements

  • MD or DO degree
  • 5+ years post-residency clinical experience
  • Board certification by ABMS or AOA
  • Current unrestricted medical license
  • No federal or state sanctions

Work Rights

Not specified

Tailored Resume

Cover Letter