Inpatient Utilization Review Medical Director

Humana Inc; Trenton (NJ); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana Inc. is seeking a Medical Director to oversee inpatient medical necessity reviews, applying national guidelines, CMS regulations, and Humana policies to determine medical necessity.

This role emphasizes structured decision-making and collaboration with physicians across teams to impact patient outcomes while reducing variability in care. Ideal candidates bring 5+ years post-residency experience, active licenses, and board certification.

Qualifications

• MD or DO medical degree.
• 5+ years post-residency clinical experience.
• Active, unrestricted medical license; willingness to obtain additional licenses as needed.
• Current and ongoing Board Certification in an AOABPS- or ABMS-recognized medical specialty.
• Meets all credentialing requirements, with no state or federal sanctions.
• Strong analytical, communication, and documentation skills.
• Ability to work effectively within a structured environment and as part of a multidisciplinary team.

Responsibilities

• Conduct inpatient medical necessity reviews promptly and in accordance with regulatory requirements.
• Uphold excellence in productivity, accuracy, quality, and timely completion of assigned tasks.
• Communicate review outcomes clearly and professionally in both verbal and written formats.
• Demonstrate flexibility and adaptability to changing workflows, tools, and utilization management procedures.

Skills

Analytical thinking

Communication

Documentation

Multidisciplinary collaboration

Regulatory knowledge

Education

MD/DO

Board Certification

Medical license

Tools

MCG/InterQual guidelines

Utilization review software

Job description

Humana Inc. is seeking a Medical Director to oversee inpatient medical necessity reviews, applying national guidelines, CMS regulations, and Humana policies to determine medical necessity.

This role emphasizes structured decision-making and collaboration with physicians across teams to impact patient outcomes while reducing variability in care. Ideal candidates bring 5+ years post-residency experience, active licenses, and board certification.