Humana·2 days ago
2 days ago
Medical Director-Payment Integrity
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What you'll do
- determine the appropriateness of services at the inpatient level, ensuring regulatory compliance
- review clinical records
- collaborate with colleagues, making impactful decisions
What they're looking for
- board certification (abms medical specialty)
- md or do degree
- significant clinical experience
- strong understanding of Medicare requirements
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
Become part of our team as a Medical Director, where you will use your medical expertise to determine the appropriateness of services at the inpatient level, ensuring regulatory compliance. You will review clinical records and collaborate with colleagues, making impactful decisions. Ideal candidates have significant clinical experience and a strong understanding of Medicare requirements.
Skills
- board certification (abms medical specialty)
- md or do degree
- inpatient care
- clinical documentation review
- medicare requirements
- medicaid requirements
- cms requirements
- clinical scenario interpretation
- utilization management
- case management
- dispute resolution
- grievance and appeals review
- peer-to-peer communication
- quality management
- discharge planning
- managed care industry knowledge
- coding practices
- clinical standards compliance
- internal medicine
- hospitalist
- family practice
- geriatrics
- emergency medicine
- public health analytics
- population health
- business metrics
- mcg
- interqual
- clinical group practice management
- health insurance knowledge
Company
Humana
Nationwide, United States of America
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