Description

Become a part of our caring community and help us put health first
The Long-term services and supports (LTSS) Medical Director's primary responsibility is the review of medical authorizations. This review determines the medical necessity of a given service, level of care, or medical item/supply. The Medical Director's work assignments involve moderately complex to complex issues. These issues require an in-depth evaluation of variable factors, relying on clinical experience of both medicine and social determinants of health. You have a current/active Florida license and be willing to work East Coast hours. Please see position requirements for licensing details.

The Long-term services and supports (LTSS) Medical Director's primary responsibility is the review of medical authorizations. This review determines the medical necessity of a given service, level of care, or medical item/supply. The Medical Director's work assignments involve moderately complex to complex issues. These issues require an in-depth evaluation of variable factors, relying on clinical experience of both medicine and social determinants of health. You have a current/active Florida license and be willing to work East Coast hours. Please see position requirements for licensing details.

The LTSS Reviewing Medical Director may occasionally speak with entities including contracted external physicians, provider groups, health care facilities, or community groups. The goal of these conversations is to gain an understanding of Humana processes, and to focus on collaborative business relationships, values-based care, population health, or disease or care management. Medical Directors support Humana values, and Humana's mission, throughout all activities.

Use your skills to make an impact

Responsibilities

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. You support and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of mentored training, daily work is performed. Enjoy working in a structured environment with expectations for consistency in thinking and authorship. Exercise independence in meeting departmental expectations and meets compliance timelines.

Required Qualifications

• 5+ years of direct clinical patient care experience post residency or fellowship experience
• Must have a currentand unrestrictedLicense in Florida and able to obtain Licenses in Indiana, Virginia, Georgia, Michigan, and other LTSS Medicaid states
• MD or DO degree
• Current and ongoing Board Certification in an approved ABMS/AOA Medical Specialty
• 5+ years of established clinical experience
• Knowledge of the managed care industry including Medicare or Medicaid products
• Have interpretation skills with 5+ years of experience focusing on quality management, utilization management, discharge planning, rehabilitation services, and home health services
• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
• LTSS medical management organizations, Skilled Nursing Facilities, Long-term Care Facilities, Hospice, PACE, or Home Health Agencies and experience, working with health insurance other healthcare providers, and patient interaction.
• Internal Medicine, Physiatry, Family Practice, Geriatrics, Pediatrics, or Hospitalist experience
• Previous Medicare, Medicaid, and Commercial with 5+ years of experience
• Long-term Services & Supports or LTC/SNF with 5+ years of experience

Additional Information

Reports to the National LTSS Lead Medical Director.

The Medical Director conducts clinical reviews of the care received by members in assigned LTSS Medicaid states, member population, or condition type. 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. We expect no direct supervisory responsibility, though it may occur. May participate on project teams or organizational committees.

Call on average is 10 weekends per year.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range
The compensation range below 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.

$223,800 - $313,100 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.

Application Deadline: 08-23-2026
About us
Humana Inc. (NYSE: HUM) 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 - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Requisition #: R-404821

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