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Physician Director of Clinical Operations
hace 3 semanas
Clinical Expertise Opportunity:
We are seeking a skilled Medical Director with strong clinical expertise to lead our LTSS review team.
Key Responsibilities:
- Lead comprehensive reviews of patient care received by members in assigned Medicaid states, populations, or conditions.
- Maintain up-to-date knowledge of national clinical guidelines, state policies, CMS policies, and other reference materials.
- Collaborate with internal associates to prioritize daily work and ensure timely decision-making.
- Communicate complex clinical scenarios and determinations to external physicians, providers, and other stakeholders.
Essential Qualifications:
- 5+ years of clinical experience in LTSS, home health services, therapy services, consumable medical supplies, and durable medical equipment.
- Board certification in Internal Medicine, Physiatry, Family Practice, Geriatrics, Pediatrics, or Hospitalist.
- Knowledge of Medicare, Medicaid, and commercial insurance products.
About Our Company:
Humana is dedicated to delivering high-quality healthcare services that meet the unique needs of our customers.
