Physical Health Medical Director

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

📋 Description

• Utilizes their medical expertise, experience, and judgment to assess whether requested services, level of care, or service location should be approved.

• Acquires knowledge of Medicaid requirements and applies this understanding in daily operations.

• Performs computer-based evaluations of moderately complex to complex clinical scenarios.

• Reviews all submitted clinical documentation, prioritizes daily tasks, and communicates decisions to internal team members.

• Engages in care management involving clinical scenarios from both outpatient and inpatient settings.

• Conducts discussions with external physicians via phone to obtain additional clinical information or to discuss decisions made.

• May necessitate conflict resolution skills.

• May communicate with contracted external physicians, physician groups, facilities, or community organizations to align with regional market objectives.

• Upholds Humana values and the mission of our enterprise social needs team in all activities.

• Adjusts to work assignments as needed within the cluster for coverage during vacations, weekends, and holidays.

⛳️ Requirements

• Doctor of Medicine or Doctor of Osteopathy.

• Board-certified in a specialty recognized by ABMS or ABOA.

• A current and unrestricted license in at least one of the states that are part of the specific cluster, if applicable.

• A minimum of five years of post-training experience providing clinical services.

• Experience with utilization management reviews and case management within a health plan environment.

• No existing sanctions from Federal or State Governmental organizations, and capable of passing credentialing criteria.

• Preferred: Experience working with Medicaid enrollees, providers, and stakeholders in either a clinical or administrative capacity.

• Familiarity with the accreditation process (NCQA).

• Experience with CGX and MHK.

• Holds licensure through the Interstate Medical Licensure Compact.

• Possesses a medical license in at least one of the states that are part of the specific cluster.

🏝️ Benefits

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave).

• Short-term and long-term disability coverage.

• Life insurance.

• Numerous other opportunities.