Medical Director--Claims Management
Humana(1 month ago)
About this role
The Medical Director at Humana applies medical training and clinical judgment to determine appropriate services, level of care, and site of service for members. The role operates within regulatory and payer frameworks (Medicare, Medicaid, Medicare Advantage) and supports operationalizing clinical policy and guidelines. The position is remote with occasional travel and works within a multidisciplinary, compliance-focused environment.
Required Skills
- Medical Review
- Clinical Review
- Utilization Management
- Appeals Review
- Care Management
- Clinical Documentation
- Communication
- Analytic Skills
- Conflict Resolution
- Population Health
Qualifications
- MD or DO
- Board Certification (ABMS)
- Unrestricted Medical License
- MBA
- MHA
- MPH
About Humana
humana.comExplore Medicare plans and health insurance coverage to fit your lifestyle. Turning 65 or recently qualified? Sign up for Medicare coverage! Start with healthy, start with Humana.
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