Humana - Montpelier, VT
posted 4 days ago
The Medical Director in Claims Management at Humana is responsible for utilizing their medical expertise to assess and authorize requested services and levels of care for patients, primarily in inpatient settings. This role involves reviewing clinical scenarios, communicating decisions, and collaborating with external physicians to ensure compliance with Medicare and Medicare Advantage requirements. The Medical Director also engages in quality management and supports Humana's mission of promoting health and wellness in the community.