Medical Director - Northeast Region at Humana in Boise, Idaho, United States Become a part of our caring community and help us put health first The Medical Director 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.
All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources.
Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work.
The Medical Director's work includes 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.
The clinical scenarios predominantly arise from inpatient or post-acute care environments.
Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills.
Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.
The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management.
Medical Directors support Humana values, and Humana's Bold Goal mission, throughout all activities.
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.
The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services.
After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members.
Enjoys working in a To view full details and how to apply, please login or create a Job Seeker account
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US - ID - ID - Boise
February 3, 2025
Description We are committed to building a workplace where everyone feels heard and respected, and extending our culture of care so that every individual can reach their full potential. We want you to have a sense of belonging and feel valued for your contributions and the perspectives you bring....
US - ID - ID - Boise
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Post Falls
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Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Caldwell
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Idaho Falls
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Meridian
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Coeur d'Alene
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Lewiston
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&Requirements • Gastroenterology Physician • StartDate: ASAP Available Shifts: 3 days of procedures and 2 days of clinic Pay Rate: $600000.00 - $1000000.00 • ?Opportunity Highlights: • Earn a guaranteed salary of $600,000 plus production bonus • Sign-on bonus, student loan assistance, malpractice, 4...
US - ID - ID - Nampa
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Pocatello
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Meridian
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Boise
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Twin Falls
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Lewiston
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Idaho Falls
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Twin Falls
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Ardor Health Solutions is seeking a travel Physical Therapist for a travel job in Twin Falls, Idaho. & Requirements • Specialty: Physical Therapist • Discipline: Therapy • Start Date: 02/24/2025 • Duration: 13 weeks • 40 hours per week • Shift: 8 hours, days • Employment Type: Travel • Location:...
US - ID - ID - Lewiston
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Meridian
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Magnet Medical is seeking a travel Respiratory Therapist for a travel job in Meridian, Idaho. & Requirements • Specialty: Respiratory Therapist • Discipline: Allied Health Professional • Start Date: 02/24/2025 • Duration: 13 weeks • 36 hours per week • Shift: 12 hours, nights • Employment Type:...
US - ID - ID - Twin Falls
January 9, 2025
&Requirements • Allergy and Immunology Physician • StartDate: ASAP Pay Rate: $275000.00 - $350000.00 • A private practice that has several locations throughout Idaho and Nevada is adding a physician to the scenic Coeur d'Alene location. The reputation throughout the region is referred to as seeking...
US - ID - ID - Fairfield
January 31, 2025
About the facility A large hospital-based cancer center is seeking a Hematologist/Oncologist for locum tenens coverage. About the facility location You will not be bored while on assignment in Boise, Idaho. After all, few mid-sized cities can match Boises blend of cultural opportunities and outdoor...
US - ID - ID - Post Falls
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Pocatello
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Coeur d'Alene
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Caldwell
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Nampa
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Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Boise
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...
US - ID - ID - Twin Falls
January 29, 2025
Description: • Milton Hershey School (MHS) is one of the world's best private schools, where students in pre-K through 12th grade from disadvantaged backgrounds receive an exceptional career-focused education with housing, meals, and more-and all costs are covered. Thanks to the generosity of Milton...