Reviewing Medical Director

Company: Humana
Location: Atlanta
Posted on: January 17, 2020

Job Description:

Required Qualifications Bachelor's degree 5 years of technical experience A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment MD or DO degree Board Certified in an approved ABMS Medical Specialty Excellent communication skills with 5 years of established clinical experience Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab Preferred Qualifications Medical management organizations, hospitals and experience, working with health insurance other healthcare providers, patient interaction, etc. Internal Medicine, Family Practice, Geriatrics, Hospitalist clinical specialists. Previous Medicare, Medicaid, and/or Commercial experience. Additional Information The Medical Director conducts clinical reviews of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews and/or condition committees. Must hold a MD or DO and be board certified and typically reports to a Lead or Regional or Corporate Medical Director, depending on size of region/line of business. physiciancareers

Keywords: Humana, Atlanta , Reviewing Medical Director, Executive , Atlanta, Georgia