Medical Director – Acute Rehab

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess whether to approve requested services, level of care, and site of service.

• Perform computer-based evaluations of moderately complex to complex clinical cases.

• Review clinical records submitted and prioritize daily tasks.

• Communicate outcomes to internal team members.

• Provide medical interpretation and decisions regarding acute inpatient rehabilitation authorization requests.

• Ensure compliance with national clinical guidelines, CMS requirements, Humana policies, and clinical standards.

• Collaborate with team members, departments, Humana colleagues, and clinical leadership.

• Engage in structured and mentored training programs.

• Utilize critical thinking and uphold high standards in documentation and decision-making.

• Independently meet enterprise expectations and compliance deadlines.

• Conduct utilization management of care provided to members within a specific market, population, or condition type.

• Contribute to the review of grievances and appeals.

• Participate in project teams or organizational committees.

• Discuss cases with external physicians via phone to gather additional clinical information.

• Address and resolve conflicts as necessary.

⛳️ Requirements

• MD or DO degree required.

• Minimum of 5 years of direct clinical patient care experience following residency or fellowship.

• Board Certified in an approved ABMS or AOA Medical Specialty, with ongoing certification throughout employment.

• Current and unrestricted medical license in at least one jurisdiction, with willingness to obtain additional licenses.

• No current sanctions from Federal or State Governmental organizations.

• Ability to fulfill credentialing requirements.

• Strong analytical and interpretation skills.

• Previous experience in teams focused on quality management, utilization management, and acute inpatient rehabilitation.

• Knowledge of the managed care sector, including Medicare Advantage, Managed Medicaid, hospitals/Integrated Delivery Systems, health insurance, and healthcare providers.

• Experience in utilization management within a medical management review organization.

• Background in Physical Medicine and Rehabilitation, Internal Medicine, Family Practice, Geriatrics, or Hospitalist practice.

• Applicants must reside in the contiguous United States.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information.

• Home internet service with a minimum of 25 Mbps download and 10 Mbps upload speed.

• Preferred: advanced degree such as MBA, MHA, or MPH.

• Preferred: experience in Public Health, Population Health, analytics, and business metrics.

• Preferred: familiarity with Case managers or Care managers in complex case management and understanding of social determinants of health.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical, dental, and vision insurance benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Work-from-home arrangement.

• Occasional travel to Humana offices for training or meetings.