Medical Director – NorthEast Region Position Available In Essex, Massachusetts

Job Listing ID:

4318252

Job Title:

Medical Director –

NorthEast Region Application Deadline:

Open Until Filled

Job Location:

Salem

Date Posted:

07/26/2025

Hours Worked Per Week:

Not Provided Shift:

Not Provided Duration of Job:

Either Full or Part Time, more than 6 months You may contact this employer directly.
(Obtain the contact information to print or add to your jobs.)

Job Summary:

Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Use your skills to make an impact 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 and Humana colleagues After completion of mentored training, daily work is performed with minimal direction. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Required Qualifications MD or DO degree 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). Current and ongoing Board Certification an approved ABMS Medical Specialty A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. Excellent verbal and written communication skills . Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation. Preferred Qualifications Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management. Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. Experience with national guidelines such as MCG or InterQual Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists Advanced degree such as an

MBA, MHA, MPH

Exposure to Public Health, Population Health, analytics, and use of business metrics. Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. The curiosity to learn, the flexibility to adapt and the courage to innovate Additional Information Typically reports to a Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of t…

Job Classification:

Medical and Health Services Managers Access our statewide or regional occupation report for more information about wages,
employment outlooks, skills, training programs, related occupations, and more. Compensation

Salary:

Not Provided Job Requirements

Experience Required:

 See Job Summary

Education Required:

None

Minimum Age:

N/A Gender:

N/A