Medical Director - Mid West Region

Humana Insurance Company; Virginia; Remote; USD 223,000 - 314,000; Full time

Job summary

Join a leading healthcare company as a Medical Director, where you will leverage your medical expertise to ensure compliance with healthcare guidelines and improve patient care. This remote position involves collaboration with external physicians and participation in care management, focusing on value-based care and population health. The role offers a competitive salary and comprehensive benefits, making a significant impact on community health.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Retirement Plans

Paid Time Off

Disability Insurance

Life Insurance

Qualifications

• 5+ years of clinical experience post-residency, preferably including inpatient or Medicare-related care.
• Unrestricted license in at least one jurisdiction.

Responsibilities

• Interpret medical information to ensure services align with guidelines and policies.
• Collaborate with team members and leadership, performing tasks with minimal supervision.

Skills

Communication

Collaboration

Independence

Education

MD or DO degree

Board Certification by ABMS

Job description

Become a part of our caring community and help us put health first

The Medical Director actively uses their medical background, experience, and judgment to determine whether requested services, levels of care, and sites of service should be authorized. All work occurs within a regulatory compliance framework and is supported by resources such as clinical guidelines, CMS policies, reference materials, and internal conferences. Medical Directors will learn Medicare and Medicare Advantage requirements and how to apply this knowledge daily.

The role includes reviewing complex clinical scenarios via computer, evaluating submitted records, prioritizing work, communicating decisions internally, and participating in care management. Clinical scenarios mainly originate from inpatient or post-acute care settings. The role involves discussions with external physicians for additional clinical information or conflict resolution, and may include coding, documentation, grievance processes, and outpatient services within scope.

Medical Directors may also engage with contracted external physicians, facilities, or community groups to support regional priorities, focusing on collaboration, value-based care, population health, and disease management. They support Humana’s values and mission throughout their activities.

Responsibilities

The Medical Director interprets medical information to ensure services align with guidelines, CMS requirements, policies, standards, and contracts. They collaborate with team members, departments, and leadership, performing daily tasks with minimal supervision after training. The role requires independence, consistency, and meeting compliance timelines, supporting market-wide objectives and community relations.

Use your skills to make an impact

Provide medical interpretation and determinations, support teamwork, and exercise independence in a structured environment, aligning with departmental and organizational standards.

Minimum Qualifications

• MD or DO degree
• 5+ years of clinical experience post-residency, preferably including inpatient or Medicare-related care
• Board Certification by ABMS
• Unrestricted license in at least one jurisdiction, with willingness to obtain additional licenses
• No sanctions from governmental agencies and able to pass credentialing
• Excellent communication skills
• Experience in quality, utilization, or discharge management, or post-acute services

Preferred Qualifications

• Knowledge of managed care, Medicare Advantage, Medicaid, or hospital systems
• Utilization management experience in relevant organizations
• Experience with guidelines like MCG or InterQual
• Specialist in Internal Medicine, Family Practice, Geriatrics, or Emergency Medicine
• Advanced degrees (MBA, MHA, MPH)
• Experience with public health, analytics, and business metrics
• Experience with case management and social determinants of health
• Curiosity, adaptability, and innovation

Additional Information

This is a remote position with occasional travel for training or meetings. The role involves utilization management, grievance and appeals, and participation in projects or committees.

#physiciancareers

Scheduled weekly hours: 40

Pay range: $223,800 - $313,100 annually, with potential bonuses based on performance.

Humana offers comprehensive benefits supporting well-being, including medical, dental, vision, retirement plans, paid time off, disability, and life insurance.

Application deadline: 08-31-2025

About us

Humana Inc. is dedicated to putting health first through insurance and healthcare services, improving quality of life for diverse populations.

Equal Opportunity Employer

Humana does not discriminate based on race, color, religion, sex, orientation, gender identity, origin, age, disability, veteran status, or other protected categories. We promote affirmative action and employment based on valid job requirements.