Medical Director Trainer - G&A

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