Physical Health Medical Director

This is a fully remote position, open to applicants in Illinois, +4 more states.

📋 Description

• Create and implement strategies for Medicaid care and/or operations

• Utilize medical expertise, experience, and judgment to decide whether to approve requested services, levels of care, or sites of service

• Conduct computer-based evaluations of clinical scenarios and submitted medical records

• Organize daily tasks and communicate decisions to internal team members

• Engage in care management as required

• Facilitate peer-to-peer conversations with external physicians to collect clinical data or discuss decisions

• Assist regional market objectives through interactions with physicians, physician groups, facilities, and community organizations

• Emphasize collaborative business relationships, value-based care, population health, and disease or care management

• Uphold Humana values and the mission of the enterprise social needs team

• Provide coverage for clusters during vacations, weekends, and holidays as necessary

• Report directly to the Cluster Lead Medical Director

⛳️ Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathy (DO)

• Board certification in an ABMS- or ABPN-recognized specialty

• Current and unrestricted medical license in at least one state within the designated cluster

• Capability to obtain licenses in additional cluster states as needed

• Must meet onboarding prerequisites

• Minimum of five years of experience after training in providing clinical services

• Background in utilization management review and case management within a health plan environment

• No current sanctions from Federal or State Government entities

• Must be able to pass credentialing standards

• Experience interacting with Medicaid enrollees, providers, and stakeholders in clinical or administrative roles

• Familiarity with the accreditation process, including NCQA

• Experience with CGX and MHK

• Licensure through the Interstate Medical Licensure Compact

• Ability to work from a designated space without interruptions to safeguard member PHI/HIPAA information

• Home internet connection with a minimum of 25 Mbps download and 10 Mbps upload speeds

🏝️ Benefits

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

• Medical insurance

• Dental insurance

• Vision insurance

• 401(k) retirement savings plan

• Paid time off

• Company holidays

• Personal holidays

• Paid parental leave

• Paid caregiver leave

• Short-term disability coverage

• Long-term disability coverage

• Life insurance

• Support for personal wellness and informed healthcare decisions

• Occasional travel to Humana offices for training or meetings may be necessary