Medical Director - Inpatient Review
Core
Review inpatient medical records to assess medical necessity based on national guidelines, CMS regulations, and Humana policies.
Role type
Senior IC Medical Director (Utilization Review)
Builds
Utilization management determinations for inpatient care
Domain
Healthcare / Insurance / Utilization Management
Required skills
Clinical expertise, case analysis, structured decision-making, regulatory compliance, communication, documentation
Preferred skills
Hospital Medicine/Critical Care/EM background, Utilization Review experience, MCG/InterQual guidelines, Medicare population experience, clinical technology proficiency
Technologies
MCG, InterQual, clinical technology platforms
Responsibilities
Conduct inpatient medical necessity reviews, analyze complex hospital-based cases, communicate review outcomes with external providers, collaborate within a structured team environment
Seniority
Senior, hands-on IC