Medical Director Trainer - G&A

About this role

Become a part of our caring community   The Corporate Medical Director - Trainer provides training for newly hired Medical Directors. In this role, you will actively use your medical background, experience, and judgement to train new medical directors on how to make determinations whether requested services 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 references, HMCP MA policies, clinical reference materials, internal teaching conferences, Medicaid handbooks, and other reference sources. Schedule is Monday-Friday with weekend and holiday work as assigned.

  At Humana, we are committed to helping people achieve their best health by delivering care and service with humanity, clarity, collaboration, and accountability. Through the Humana Way, we bring our values to life by working together to create simpler, better, and faster experiences for our members, patients, teammates, and business partners. • Develop, coordinate, and deliver comprehensive onboarding and job-skills training for newly hired Grievances and Appeals Medical Directors.

• Provide virtual instruction to new Medical Directors on clinical review processes, authorization determinations, documentation expectations, and case decision-making standards.

• • Train Medical Directors on the appropriate use of medical judgment, clinical experience, and evidence-based resources when determining whether requested services should be authorized.

• Educate trainees on the application of national clinical guidelines, CMS references, HMCP Medicare Advantage policies, Medicaid handbooks, clinical reference materials, and other applicable resources.

• Reinforce regulatory compliance requirements throughout the training process, including expectations related to grievances, appeals, utilization management, documentation, and decision rationale.

• Respond to trainee questions in a timely, accurate, and supportive manner, providing clarification on clinical, operational, regulatory, and policy-related topics.

• Provide individualized coaching, feedback, and support to newly hired Medical Directors to promote consistent, thorough, and compliant clinical decision-making.

• Collaborate with Clinical Operations leadership, Corporate, Division and Market leaders, Humana’s Learning Center, Risk and Compliance, Audit, Legal, the UM Center of Excellence, Lead Medical Directors, and other key partners to align training content with business and regulatory needs.

• Support quality auditing functions by reviewing training outcomes, identifying performance trends, and assisting with education or remediation plans as needed.

• Coordinate and communicate MCG updates, ensuring Medical Directors understand changes to clinical criteria and how to apply updated guidance in case reviews.

• Assist with Clinical Criteria Committee development and education, including preparation of training materials, communication of updates, and support for consistent implementation.

• Support inter-rater reliability development, required meetings, teaching conferences, operational initiatives, and other activities that promote consistency, accuracy, and compliance across the Grievances and Appeals Medical Director team.

Use your skills to make an impact   Required Qualifications • MD or DO degree from an accredited university

• An active and unrestricted license in at least one jurisdiction. Willing and able to obtain an unrestricted license, as required, for various states in region of assignment

• Board Certified in an approved ABMS or AOA Medical Specialty

• Schedule is Monday-Friday with weekend and holiday work as assigned.

• Excellent verbal and written communication skills that are prompt and professional with internal and external stakeholders

• 5 years of established post-residency clinical experience

• Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications • Medical utilization management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.

• Internal Medicine, Family Practice, Geriatrics, Hospitalist, Anesthesiology, Physical Medicine and Rehabilitation, Emergency Medicine, Neurology, and General Surgery clinical specialists.

Interview Format  As part of our hiring process, we will be using on-demand technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making through on-demand candidate assessments. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in an on-demand assessment with pre-determined questions. You should anticipate the assessment to take approximately 10-15 minutes. Your on-demand assessment will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

SSN Task via Workday Should you be extended a formal employment offer you will receive a request to enter your SSN into our Workday system to scan for duplicate profiles.

#GreivancesAndAppeals #G&ATrainer This is a remote position

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if neces

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