Medical Director - Acute Rehab

Humana Inc; Northern (KY); Hybrid; USD 224,000 - 313,000; Full time

Job summary

Humana Inc. seeks a Medical Director for Acute Rehab to authorize requests and ensure alignment with national guidelines and CMS requirements. The role leverages clinical judgment, with oversight of complex cases and collaboration across Humana teams.

The position is remote nationwide with a standard 40-hour week, requiring board-certified expertise, an active medical license, and strong utilization management experience in a post-acute setting.

Qualifications

• MD/DO degree with board certification.
• Current unrestricted license in at least one state.
• 5+ years of direct clinical care post-residency.
• Experience in inpatient settings, preferably acute rehab.
• Knowledge of Medicare Advantage and managed Medicaid.

Responsibilities

• Provide medical interpretation and determinations on acute inpatient rehabilitation authorization requests.
• Collaborate with team members and clinical leadership to support review processes and quality outcomes.
• Participate in structured training programs and ongoing mentorship.
• Maintain high standards of documentation, decision-making, and compliance.

Skills

MD/DO degree

Board Certified

Unrestricted license

Utilization management

Analytics & interpretation

Acute rehab experience

Education

MD/DO degree

Board Certification (ABMS/AOA)

Job description

## Medical Director - Acute RehabApply: Remote Nationwide: Full time: Posted Today: R-432280# **Become a part of our caring community**The Medical Director uses their medical background, experience, and judgement to determine whether to authorize requested services, requested level of care, and requested site of service. All work occurs within a context of regulatory compliance, and diverse resources assist work, including national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work specifically for DSNP. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, and communication of decisions to internal associates. The clinical scenarios predominantly arise from post-acute care environments. The work includes discussions with external physicians by phone to gather additional clinical information or discuss determinations, and in some instances, these may require conflict resolution skills.**Responsibilities*** Provide medical interpretation and determinations on acute inpatient rehabilitation authorization requests, ensuring alignment with national clinical guidelines, CMS requirements, Humana policies, and clinical standards.* Collaborate with team members, other departments, Humana colleagues, and clinical leadership to support the review process and facilitate quality outcomes.* Participate in and complete structured and mentored training programs; utilize ongoing team support during daily work activities.* Consistently apply critical thinking and maintain high standards in documentation and decision-making within a structured work environment.* Exercise independence in fulfilling enterprise expectations and meeting compliance timelines.* This is a full-time, remote position with a standard schedule of forty hours per week; the role may be performed from any location within the United States.**Required Qualifications*** MD or DO degree* 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and related to acute inpatient rehabilitation.* Board Certified in an approved ABMS or AOA Medical Specialty with continued certification throughout employment.* A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s).* 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 quality management, utilization management, and acute inpatient rehabilitation.* Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers.* Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid.* Physical Medicine and Rehabilitation, Internal Medicine, Family Practice, Geriatrics, or Hospitalist background**Preferred*** Advanced degrees 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.# **Use your skills to make an impact****Additional Information**Typically reports to a Regional/Associate Vice President, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also contribute to grievance and appeals reviews. Some medical directors may join a centralized team for several months after training, until positions become available for specific markets. May participate on project teams or organizational committees. **Work Style:** This is a fully remote position, applicants must live in the contiguous United States. Occasional travel to Humana's offices for training or meetings may be required. **Work Hours:** Typical business hours are Monday-Friday 40 hours per week (start as early as 6am, no later than 9am; some flexibility might be possible, depending on business needs. **Interview Format:**As part of our hiring process, we will be using on-demand technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers with an enhanced method for decision-making through on-demand candidate assessments.If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in an on-demand assessment with pre-determined questions. You should anticipate the assessment to take approximately 10-15 minutes.Your on-demand assessment will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews. **SSN Task via Workday:** Should you receive a formal employment offer, you will receive a request to enter your SSN into our Workday system to scan for duplicate profiles.**Reporting Structure:** The Compliance Professional 2 reports to the Manager, ComplianceWork at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.**Scheduled Weekly Hours**40**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 yearThis 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 10-29-2026