Physician, Medical Director – MedSpas
Moxie
Medical Director
Humana
full-time
Posted on:
Location Type: Hybrid
Location: 🇺🇸 United States
Visit company websiteSalary
💰 $223,800 - $313,100 per year
Job Level
Lead
About the role
- 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
Requirements
- MD or DO degree
- Current and ongoing board certification in an approved ABMS Medical Specialty
- A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment
- 5+ years of direct clinical patient care experience post residency or fellowship
- No sanctions from Federal or State Governmental organizations
- The ability to pass credentialing requirements
- Excellent verbal and written communication skills with analytic and interpretative skills
- Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution
- Experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age) (Preferred)
- Internal Medicine, Family Practice, Geriatrics, Physiatry, Emergency Medicine, Critical Care or hospital based clinical specialists (Preferred)
- Ability to function in a dynamic fast paced environment (Preferred)
- Commitment to a culture of innovation (Preferred)
- Knowledge and experience with national guidelines such as NCD/LCD, MCG® or InterQual (Preferred)
Benefits
- Competitive benefits that support whole-person well-being
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
- This job is eligible for a bonus incentive plan
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
MD degreeDO degreeboard certificationclinical case reviewsmedical interpretationclinical standardsMedicare requirementsMedicare Advantage requirementsNCD/LCDMCG®
Soft skills
verbal communicationwritten communicationanalytical skillsinterpretative skillscollaborative relationshipsdynamic environment adaptabilitycommitment to innovation
Certifications
current and unrestricted medical license
