Inpatient Utilization Review Medical Director

Humana; United States; Remote; USD 228,000 - 309,000; Full time

Job summary

Humana is seeking a Medical Director to provide expert inpatient medical necessity reviews, leveraging national guidelines, CMS regulations, Humana policies, and clinical standards.

This role emphasizes case analysis, structured decision-making, collaboration with providers, and impact on patient outcomes, with typical Monday–Friday hours and a remote work setup. Occasional travel to Humana offices may be required.

Qualifications

• MD or DO with active, unrestricted medical license in at least one state.
• Board certification in an AOABPS- or ABMS-recognized specialty.
• Minimum 5 years post-residency clinical experience.
• Strong analytical, communication, and documentation skills.
• Ability to work effectively within a structured, multidisciplinary team.

Responsibilities

• Perform inpatient medical necessity reviews per guidelines and Humana policies.
• Analyze complex hospital cases and provide clear utilization decisions.
• Communicate review outcomes with external providers by phone.
• Collaborate in a structured, professional team environment.
• Support Humana’s mission with high-quality decision-making.

Skills

Analytical skills

Communication

Documentation

Team collaboration

Education

MD/DO degree

Job description

Humana is seeking a Medical Director to provide expert inpatient medical necessity reviews, leveraging national guidelines, CMS regulations, Humana policies, and clinical standards.

This role emphasizes case analysis, structured decision-making, collaboration with providers, and impact on patient outcomes, with typical Monday–Friday hours and a remote work setup. Occasional travel to Humana offices may be required.