Medical Director – Inpatient Utilization (Remote)

Humana Inc; Helena (MT); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work option

Job summary

Humana Inc. is seeking a Medical Director to determine inpatient service authorizations in a compliant, guideline-driven framework. You will review complex clinical scenarios, assess records, and communicate decisions. This role may include peer discussions with external providers and occasional coding or documentation scope.

You will work with the team to ensure quality management and utilization review while supporting Humana values and mission.

Qualifications

• MD or DO medical degree and active license in at least one jurisdiction.
• 5+ years of direct clinical patient care post residency or fellowship.
• Current, unrestricted board certification in an approved ABMS medical specialty.
• Ability to obtain additional licenses if required.
• No current sanctions from federal or state authorities; credentialing clear.
• Strong verbal and written communication skills; collaborative mindset.
• Experience in quality/utilization/case management in post-acute care.

Responsibilities

• Provide medical interpretation and determinations aligned with guidelines and CMS requirements.
• Collaborate with team members, departments, and Lead Medical Director.
• Perform daily work with minimal direction after mentored training.
• Support market-wide goals and community relations as directed.

Skills

MD/DO degree

Clinical experience

Board certification

Licensure

No sanctions

Communication skills

Analytic skills

Education

MD or DO degree

ABMS board certification

Job description

Humana Inc. is seeking a Medical Director to determine inpatient service authorizations in a compliant, guideline-driven framework. You will review complex clinical scenarios, assess records, and communicate decisions. This role may include peer discussions with external providers and occasional coding or documentation scope.

You will work with the team to ensure quality management and utilization review while supporting Humana values and mission.