Medical Director-Payment Integrity

A Medical Director at Humana utilizes their medical background and judgment to determine the authorization of inpatient services, levels of care, and sites of service within a regulatory compliance context. The role involves reviewing complex clinical scenarios, communicating decisions to internal associates, and supporting market-wide objectives while adhering to Medicare, Medicaid, and CMS requirements. After mentored training, the position requires independent work with minimal direction in a structured environment.