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Lead Medical Director at Humana - ApplyBlast

Lead Medical Director

Humana

3 months ago

3.6 on Glassdoor

Remote

Full Time

Director

0 applicants

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About this role

The Lead Medical Director provides clinical and operational leadership for medical review activities across home health, skilled nursing, durable medical equipment, and Medicare/Medicaid dual-eligible requests. This role oversees a team of Medical Directors, ensures compliance with CMS and regulatory requirements, and drives timely, fair, evidence‑based medical necessity determinations.

Responsibilities

Oversee daily operations of Medical Director team
Conduct clinical case reviews and medical necessity determinations
Ensure compliance with CMS Medicare and Medicaid regulations
Lead process improvement initiatives for home care services
Collaborate with cross‑functional partners to align medical review practices

Skills

Qualifications

Doctor of Medicine (MD/DO) degreeBoard certification in an approved ABMS Medical SpecialtyActive unrestricted medical license

About Humana

humana.com

Headquarters

Louisville, Kentucky, United States

Company Size

10001+ employees

Founded

1961

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