Medical Director, Inpatient Utilization & Review

Humana Inc; Concord (NH); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus plan

Competitive benefits

Job summary

Humana Inc. is seeking a Medical Director to lead inpatient medical necessity reviews, leveraging national guidelines, CMS regulations, and Humana policies. The role emphasizes structured decision-making, collaboration with physicians, and high-quality patient outcomes without bedside demands.

The ideal candidate has MD/DO, 5+ years post-residency, active license, and board certification, with strong analytics and communication skills. Remote work with occasional travel is expected.

Qualifications

• MD or DO is required.
• 5+ years post-residency clinical experience is required.
• Active, unrestricted medical license in at least one state; willingness to obtain more.
• Board Certification in AOABPS- or ABMS-recognized specialty.
• Meets credentialing requirements with no sanctions.
• Strong analytical, communication, and documentation skills.
• Ability to work in a structured, multidisciplinary team.

Responsibilities

• Perform expert clinical review of inpatient medical records and assess medical necessity.
• Analyze complex hospital-based cases and deliver utilization management determinations.
• Communicate with external providers to obtain clinical information and discuss outcomes.
• Collaborate in a team-oriented environment with integrity and professionalism.
• Advance Humana’s mission by supporting high-quality decision-making and physician partnerships.

Skills

Analytical skills

Communication skills

Documentation skills

Teamwork

Education

MD or DO

Board Certification in AOABPS- or ABMS-recognized specialty

5+ years post-residency clinical experience

Job description

Humana Inc. is seeking a Medical Director to lead inpatient medical necessity reviews, leveraging national guidelines, CMS regulations, and Humana policies. The role emphasizes structured decision-making, collaboration with physicians, and high-quality patient outcomes without bedside demands.

The ideal candidate has MD/DO, 5+ years post-residency, active license, and board certification, with strong analytics and communication skills. Remote work with occasional travel is expected.