South Dakota Jobs

South Dakota Department of Labor & Regulation mobile logo

Job Information

Humana Lead Medical Director - Must live in IL, MN, ND, SD, or WI in Aberdeen, South Dakota


The Lead Medical Director relies on medical background and reviews health claims. The Lead Medical Director requires a solid understanding of how organization capabilities interrelate across department(s).


The Lead 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. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates.

  • The Lead Medical Director oversees the work of Medical Directors who conduct clinical case reviews of the care received by members in an assigned market, member population, or condition type and may also spend a portion of their time doing case reviews themselves. The Lead Medical Director may also lead specific functional area in addition to leading a team of Medical Directors. Must hold a MD or DO and be board certified and typically reports to a Regional or Corporate Medical Director. Supervisory responsibility of at minimum 4-5 other physicians (and perhaps clinicians) is expected. Other duties include:

  • Identify and drive implementation of medical management improvements, including those within the medical director area.

  • Maintain medical director schedule (PTO, weekend coverage, etc.).

  • Monitor key operational and utilization metrics to identify opportunities for improvement.

  • Assist with development and implementation of clinical initiatives identified within the region and/or corporate clinical areas, and as proposed by provider partners.

  • Develop collaborative relationships with outside physician leaders, including support for escalated case and process concerns.

  • Support provider engagement, operational, and other meetings.

  • Promote collaboration and wellness within the regional medical management team.

  • Foster development of medical directors through non-case review activities.

  • Other activities as assigned by the RVP-Health Services.

Required Qualifications

  • Bachelor's Degree

  • 2 or more years of management experience

  • A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment

  • MD or DO degree

  • Board Certified in an approved ABMS Medical Specialty

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

  • Residence in a North Central Region state (IL, MN, ND, SD, WI)

Preferred Qualifications

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

  • Internal Medicine, Family Practice, Geriatrics, Hospitalist clinical specialists

  • Previous Medicare, Medicaid, and/or Commercial experience


Scheduled Weekly Hours