Medical Director, Inpatient Care & Utilization

Humana Inc; Lansing (MI); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana Inc. is seeking a Medical Director to apply medical judgment to authorize inpatient services in line with national guidelines, CMS requirements, and Humana policies.

The role emphasizes collaboration with teams, mentoring, and consistent clinical decision-making across populations. You will review complex cases, engage in utilization and discharge planning, and support quality management initiatives while remaining compliant with licensure and credentialing standards.

Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care experience post residency or fellowship, inpatient preferred.
• Current and ongoing ABMS board certification.
• Current and unrestricted medical license; willing to obtain additional license.
• No sanctions and able to pass credentialing.
• Excellent verbal and written communication skills.
• Experience in quality management, utilization management, case management, discharge planning or post-acute services.

Responsibilities

• Provide medical interpretation and determinations whether services align with guidelines, CMS requirements, Humana policies and clinical standards.
• Collaborate with team members and other departments; mentor and communicate decisions.
• Handle mentored training and perform daily work with minimal direction.
• Support market-wide objectives and community relations as directed.

Skills

Excellent verbal and written commu­n

Analytic and interpretation skills

Team collaboration

Education

MD or DO degree

ABMS Board Certification

Active medical license in at least one jurisdiction

Job description

Humana Inc. is seeking a Medical Director to apply medical judgment to authorize inpatient services in line with national guidelines, CMS requirements, and Humana policies.

The role emphasizes collaboration with teams, mentoring, and consistent clinical decision-making across populations. You will review complex cases, engage in utilization and discharge planning, and support quality management initiatives while remaining compliant with licensure and credentialing standards.