Medical Director - Acute Inpatient Rehabilitation

Become a part of our caring community and help us put health first

The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and / or requested site of service should meet authorization requirements.

All work occurs within a context of regulatory compliance, assisted by diverse resources including national clinical guidelines, CMS policies and determinations, clinical reference materials, and internal teaching conferences.

Medical Directors will learn Medicare and Medicare Advantage requirements and operationalize this knowledge in their daily work.

The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, and communication of decisions to internal associates.

The clinical scenarios predominantly arise from post-acute care environments. The work includes discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, which may require conflict resolution skills.

Responsibilities

• Provide medical interpretation and determinations on whether acute inpatient rehabilitation authorization requests align with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.
• Support and collaborate with other team members, departments, Humana colleagues, and clinical leadership.
• Perform daily work with minimal direction after completion of structured and mentored training, with support from team members.
• Work in a structured environment with expectations for consistency in thinking and authorship.
• Exercise independence in meeting enterprise expectations and compliance timelines.
• Complete other duties as assigned.

This is a full-time (approximately 40 hours) work from home opportunity. Candidates may live anywhere in the US and work forty hours per week.

Use your skills to make an impact

Required Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care experience post residency or fellowship, preferably including some experience in an inpatient environment and / or related to acute inpatient rehabilitation.
• Board Certified in an approved ABMS Medical Specialty or AOA (American Osteopathic Association) with continued certification throughout employment.
• A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s), if required.
• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, and acute inpatient rehabilitation.

Preferred Qualifications

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid, or other Medical management organizations, hospitals / Integrated Delivery Systems, health insurance, and other healthcare providers.
• Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid.
• Physical Medicine and Rehabilitation, Internal Medicine, Family Practice, Geriatrics, or Hospitalist background.
• Advanced degree such as an MBA, MHA, or MPH.
• The curiosity to learn, the flexibility to adapt, and the courage to innovate.

Additional Information

The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type, and may engage in grievance and appeals reviews.

Some medical directors may join a centralized team for several months after training, until positions become available for specific markets.

May participate on project teams or organizational committees.

Work at Home Guidance

To ensure Home or Hybrid Home / Office associates' ability to work effectively, the self-provided internet service must meet the following criteria :

Have you got the right qualifications and skills for this job Find out below, and hit apply to be considered.

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Associates who live and work from Home in California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Scheduled Weekly Hours

Pay Range

The compensation range reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting.

The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, etc.

$199,400 - $274,400 per year. This job is eligible for a bonus incentive plan based on company and / or individual performance.

Description of Benefits

Humana, Inc. offers competitive benefits that support whole-person well-being, including 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, and many other opportunities.

About us

Humana Inc. is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health.

Equal Opportunity Employer

Humana does not discriminate against any employee or applicant for employment based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status.

This policy applies to all employment actions, including recruitment, hiring, promotion, and termination.

J-18808-Ljbffr