Medical Director, Inpatient Utilization Review

Humana Inc; Olympia (WA); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana Inc. is seeking a Medical Director to lead inpatient medical necessity reviews and drive high-quality utilization management. The ideal candidate has extensive clinical experience, an active license, and board certification, working within a multidisciplinary Humana team.

The role emphasizes structured decision-making, collaboration with providers, and alignment with CMS/national guidelines, with work-from-home flexibility and periodic travel as needed.

Qualifications

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

Responsibilities

• Perform expert inpatient medical necessity reviews per regulatory requirements and Humana policies.
• Analyze complex hospital-based cases and issue clear utilization management determinations.
• Communicate review outcomes with external providers by phone and in writing.
• Collaborate within a structured, team-oriented environment with integrity and professionalism.

Skills

Analytical skills

Communication skills

Documentation skills

Team collaboration

Education

MD or DO

Job description

Humana Inc. is seeking a Medical Director to lead inpatient medical necessity reviews and drive high-quality utilization management. The ideal candidate has extensive clinical experience, an active license, and board certification, working within a multidisciplinary Humana team.

The role emphasizes structured decision-making, collaboration with providers, and alignment with CMS/national guidelines, with work-from-home flexibility and periodic travel as needed.