Medical Director

• Rely on fundamentals of CMS Medicare Guidance when reviewing home health, SNF, DME, dual Medicare/Medicaid and Waiver requests
• Provide medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts
• Provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards
• Use diverse resources including national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise
• Learn Medicare and Medicare Advantage requirements and operationalize this knowledge in daily work
• Work in a structured environment with expectations for consistency in thinking, authorship, meeting departmental expectations, and compliance timelines
• Conduct clinical case reviews of requests received by members of the Medicare population and report to the Lead Medical Director
• Identify medical management operational improvements, including those within the medical director area
• Participate in call rotation which may include weekend coverage
• Develop collaborative relationships with Team and key partners within the Medicare Line of Business
• Support Home Solutions as needed
• Perform other activities as assigned by the managing Medical Director
• Occasional travel to Humana's offices for training or meetings may be required
• Scheduled Weekly Hours 40

Medical Director

Area Medical Director

Clinical Director – BCBA

Medical Director

Global Medical Director, Dermatology, Ritlecitinib

Clinical Director