Utilization Management Medical Director

Conviva Senior Primary Care Louisville, KY 40202, US

$223,800 - $313,100 / year

Become a part of our caring community and help us put health first

As a UM medical director, you will rely on medical background and review health claims. Your work assignments will involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

You will provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. You will make decision on moderately complex to complex issues regarding technical approach for project components. Your work is performed autonomously so you will exercise considerable latitude in determining objectives and approaches to assignments.

Use your skills to make an impact

Required Qualifications

MD or DO degree
Three 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, or other board demonstrating advanced training in transitions of care, quality assurance, utilization management and care coordination.
A current and unrestricted medical license in at least one jurisdiction and willing to obtain additional license.
No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on transitions of care, 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 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, and 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.
ABQAURP cerification

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$223,800 - $313,100 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 06-29-2026

About us

About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.

About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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