Medical Director - OneHome
Humana International Group·Remote(United States)
Healthcare
Excel
WFA Digital Insight
As demand for healthcare professionals grows, medical directors with strong clinical skills and regulatory knowledge are in high demand. With 10 years of direct patient care experience required, this role stands out for its focus on putting health first. Candidates should be prepared to apply their expertise in a remote setting and navigate complex regulatory standards.
Job Description
About the Role
The Medical Director plays a critical role in reviewing and determining the medical necessity of healthcare services provided to Medicare and Medicaid members.Responsibilities
- Review clinical cases and determine medical necessity of services
- Ensure compliance with review policies, procedures, and regulatory standards
- Apply clinical guidelines, CMS policies, and Medicare/Medicare Advantage/Medicaid requirements
Requirements
- MD or DO degree
- Current, active, and ongoing board certification
- Current and unrestricted state license in at least one state
- 10 years of direct clinical patient care experience post-residency or fellowship
- Intermediate to advanced skills utilizing Microsoft Office, including Excel
How to Stand Out
- Be prepared to provide specific examples of your experience with clinical guidelines and regulatory standards
- Highlight your ability to work independently in a remote setting and manage multiple priorities
- Develop a strong understanding of CMS policies and Medicare requirements to stand out in the application process
- Prepare to discuss your experience with electronic medical records and healthcare technology systems
- Showcase your analytical skills, including proficiency in Excel, to demonstrate your ability to interpret complex data
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