Home Solutions Medical Director - Remote US

Become a part of our caring community and help us put health first
 The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic and per diem requests. The Medical Director provides 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.

Consolidation of work to central team and absorption of vendor work as part of Project GrowthThe Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise.  Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work. After completion of mentored training, daily work is performed with minimal direction. The Medical Director works in a structured environment with expectations for consistency in thinking, authorship, meeting departmental expectations, and compliance timelines.

Use your skills to make an impact
 

Required Qualifications

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 …