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About the role
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- MD or DO degree
- A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required
- Current and ongoing Board Certification with preference for Internal Medicine, Family Medicine, Emergency Medicine or Physical Medicine and Rehabilitation
- 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, or similar activities
More about this role
**Please note that this Medical Director position is a part-time, seasonal position, with variable/flexible weekly hours. The position is non-benefitted and compensated hourly**
The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D and B). The Medical director work assignments involve moderately complex to complex issues where the analysis of situations or data requires a case-by-case consideration of the Medicare rules, Humana policies and medical necessity.
The Medical Director will collaborate with clinicians and support staff to provide Humana members with optimal value-based care in accordance with Medicare and Humana policy. All work occurs within a context of regulatory compliance and work is assisted by diverse resources, included but not limited to CMS policies, National and Local Coverage Determinations, CMS-recognized Compendia, NCCN, Humana Pharmacy Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D and Medicare Advantage requirements and will understand how to operationalize this in their daily work.
The Medical Director's work includes computer-based review of...
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