Medical Director - Care Plus - Florida - Remote

Overview

The Medical Director relies on medical background and reviews health claims, making determinations on service authorizations based on clinical scenarios.

In Short

• Responsible for medical interpretation and determinations regarding healthcare services.
• Requires valid Florida Medical license and ability to start within 30-60 days of hire.
• Engages in utilization management and compliance with national guidelines.
• Communicates decisions to internal associates and external physicians.
• Participates in care management and quality management initiatives.
• Works in a structured environment with minimal direction after training.
• Must have 5+ years of clinical patient care experience.
• Experience in inpatient care and Medicare populations preferred.
• Supports Humana values and Bold Goal mission.
• May require occasional travel to Humana's offices for training.

Requirements

• MD or DO degree with valid Florida Medical license.
• 5+ years of direct clinical patient care experience.
• Current and ongoing Board Certification in an approved ABMS Medical Specialty.
• Excellent verbal and written communication skills.
• Experience in utilization management and healthcare compliance.
• Knowledge of managed care industry and Medicare Advantage.
• Preferred experience in Internal Medicine, Family Practice, or Geriatrics.
• Ability to work collaboratively with team members and external stakeholders.
• Familiarity with coding practices and clinical documentation.
• Curiosity to learn and flexibility to adapt.

Benefits

• Competitive medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability insurance.
• Life insurance and other opportunities.