# Medical Director **Company**: Humana Inc. **Location**: Remote Nationwide **Work arrangement**: remote **Experience**: senior **Job type**: full-time **Salary**: $223,800 - $313,100 per year **Category**: Healthcare **Industry**: Healthcare **Apply**: https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Nationwide/Medical-Director---Physical-Health_R-436789?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/job/medical-director-73f6e21f-0d3/ ## Description The Medical Director is responsible for Medicaid care strategy and/or operations. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Responsibilities: - Uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, or requested site of service should be authorized, with all work occurring within a context of regulatory compliance and assisted by diverse resources. - Learns Medicaid requirements and understands how to operationalize this knowledge in their daily work in their assigned cluster. - Work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. - Conducts discussions with external physicians by phone to gather additional clinical information or discuss determinations through the peer-to-peer process. - May speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities. - Supports Humana values and our enterprise social needs team mission throughout all activities. - Flows to work as needed within cluster as needed for vacations, weekends and holidays coverage. Qualifications: - Doctor of Medicine or Doctor of Osteopathy. - Board-certified in an AOABPS or ABMS recognized medical specialty. - A current and unrestricted license at the offer stage in at least one of the states that are part of the specific cluster, and the ability to obtain licenses without conditions in the other cluster states based on assigned region. - Able to satisfy onboarding requirements. - At least five years of experience post-training providing clinical services. - Experience in utilization management review and case management in a health plan setting. - No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. - Experience working with Medicaid Enrollees, providers, and stakeholders in a clinical or administrative setting. - Experience with accreditation process (NCQA). - Experience with CGX and MHK. - Has licensure through the Interstate Medical Licensure Compact (IMLC). Preferred Qualifications: - Experience working with Medicaid Enrollees, providers, and stakeholders in a clinical or administrative setting. - Experience in utilization management review and case management in a health plan setting. Reporting Relationship: This position reports directly to the Cluster Lead Medical Director. Work Hours: Typical business hours are Monday-Friday start time no later than 9am EST with some flexibility might be possible, depending on business needs. Scheduled Weekly Hours: 40 Pay Range: $223,800 - $313,100 per year Description of Benefits: Humana, Inc. and its affiliated subsidiaries offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. For more fresh new jobs, check out [yubhub.co](https://yubhub.co/). ## Skills ### Required - Medicaid - utilization management - case management - NCQA - CGX - MHK - Interstate Medical Licensure Compact (IMLC) --- Source: [Apply at humana.wd5.myworkdayjobs.com](https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Nationwide/Medical-Director---Physical-Health_R-436789?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)