Job description

**must be local to Milwaukee WI**
Medical Director Responsibilities:

• 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 be authorized.
• Work includes a computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management.
• Will have discussions with external physicians by phone to gather additional clinical information or discuss determinations through the Peer 2 Peer process, and in some instances, these may require conflict resolution skills.
• Other duties include, but may not be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy), and reviews for DME, genetic testing, etc. within their scope.
• May occasionally speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of the clients processes, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management. Medical Directors support Humana's values, and the clients Bold Goal mission, throughout all activities.

Educational and Experience Requirements:

• Physician with a current, unencumbered license
• Board-certified in specialty
• At least five (5) years of experience post-training providing clinical services
• Three (3) years of experience working with Medicaid plan members in a clinical and/or administrative setting preferred

#INDPM

Job Type: Full-time

Pay: $103.98 per hour

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Schedule:

• 8 hour shift

Application Question(s):

• vaccine with boosters

Education:

• Doctorate (Required)

Experience:

• post-training providing clinical services: 5 years (Required)
• working with Medicaid plan members: 3 years (Required)

License/Certification:

• Physician with a current, unencumbered license (Required)

Willingness to travel:

• 25% (Preferred)

Work Location: Remote

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