Medical Director Medicaid
Humana(1 month ago)
About this role
The Medical Director at Humana applies medical expertise to review clinical records and determine authorization of services and appropriate levels or sites of care, primarily for inpatient and post-acute scenarios. The role operates within regulatory and Medicare/Medicare Advantage frameworks and supports regional market and population health objectives.
Required Skills
- Medical Review
- Clinical Judgment
- Utilization Management
- Care Management
- Communication Skills
- Regulatory Compliance
- Prior Authorization
- Clinical Documentation
- Conflict Resolution
- Population Health
Qualifications
- MD Degree
- DO Degree
- Board Certification (ABMS)
- Unrestricted Medical License
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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