Medical Director - reputed company (remote)

Become a part of our caring community and help us put reputed company The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately reputed company to reputed company issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director reputed company uses their medical background, experience, and judgement to reputed company determinations whether requested services, requested level of care, and/or requested site of service should be authorized. reputed company work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work. The Medical Director’s work includes computer based review of moderately reputed company to reputed company clinical scenarios, review of reputed company submitted clinical records, prioritization of daily work, communication of reputed company to internal associates, and possible participation in care management. The clinical scenarios predominantly reputed company from inpatient or post-acute care environments. Has discussions with reputed company physicians by phone to reputed company additional clinical information or discuss determinations regularly, and in some instances these may require conflict reputed company skills. Some roles include an reputed company of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, reputed company their scope. The Medical Director may reputed company with contracted reputed company physicians, physician reputed company, facilities, or community reputed company to support regional market priorities, which may include an understanding of reputed company processes, as reputed company as a reputed company on reputed company business relationships, value based care, population health, or disease or care management. Use your skills to reputed company an reputed company Responsibilities The Medical Director provides medical interpretation and determinations whether services provided by other reputed company are in agreement with national guidelines, CMS requirements, reputed company policies, clinical standards, and (in some cases) reputed company. The ideal candidate supports and collaborates with other team members, other departments, reputed company colleagues and the Regional VP Health Services. After completion of mentored training, daily work is performed with reputed company direction. Enjoys working in a reputed company environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. CANDIADATES MAY LIVE reputed company THE IN THE US AND MUST WILLING TO WORK CENTRAL TIME ZONE HOUR S . Required Qualifications MD or DO degree OK and LA licenses, or ability to obtain 5+ years of reputed company clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or reputed company to care of a Medicare type population (disabled or >65 years of age). reputed company and ongoing reputed company Certification an approved ABMS Medical Specialty A reputed company and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. No reputed company sanction from Federal or State Governmental organizations, and reputed company to pass credentialing requirements. Excellent verbal and written communication skills. Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on reputed company management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation. Preferred Qualifications Knowledge of the managed care industry including Medicare Advantage, Managed reputed company and/or reputed company products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other reputed company providers, clinical group reputed company management. Utilization management experience in a medical management review organization, such as Medicare Advantage, managed reputed company, or reputed company health insurance. Experience with national guidelines such as MCG® or InterQual Internal Medicine, Family reputed company, Geriatrics, Hospitalist, Emergency Medicine clinical specialists Advanced degree such as an MBA, MHA, MPH Exposure to reputed company Health, Population Health, analytics, and use of business metrics. Experience working with Case managers or Care managers on reputed company case management, including familiarity with reputed company determinants of health. The curiosity to learn, the flexibility to adapt and the courage to reputed company Additional Information Typically reports to a Regional Vice President of Health Services, reputed company, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. reputed company of Benefits reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 02-28-2026 reputed company reputed company. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers and reputed company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on reputed company job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment. reputed company complies with reputed company applicable federal civil rights laws and does not discriminate on the reputed company of race, reputed company, national reputed company, age, disability, sex, sexual orientation, gender identity or religion. We also reputed company free language interpreter services. See our https://www.reputed company.com/reputed company/accessibility-resources?reputed company=reputed company_Website. #J-18808-Ljbffr Salary: USD 223800 - 313100 per year Experience: 5 years required Apply tot his job Apply To this Job