National Medical Director Remote Utilization Leadership

Humana Inc; Santa Fe (NM); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Job summary

Humana Inc. is seeking a Medical Director to oversee preauthorization decisions, utilizing medical judgment to determine appropriate services, levels of care, and sites of service in a regulatory-compliant framework.

You will analyze complex clinical data, review records, and collaborate with care teams to ensure timely and accurate determinations. Remote work within the contiguous US is supported, with travel as needed.

Qualifications

• MD or DO degree.
• Board certification in an ABMS specialty.
• Current and unrestricted license in at least one jurisdiction.
• No current sanction from Federal or State Governmental organizations; credentialing requirements met.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills.
• Willingness to obtain additional license if required.
• Utilization Management of member care within a specified market.

Responsibilities

• Provide medical interpretation ensuring services align with guidelines, CMS requirements, Humana policies, and clinical standards.
• Collaborate with team members, Humana colleagues, and Regional VP Health Services.
• Perform daily responsibilities with mentorship and gradually increased independence.
• Maintain consistent clinical reasoning and authored determinations.
• Contribute to project teams or organizational committees.
• Engage in grievance and appeals reviews as needed.
• Communicate decisions to internal associates and external physicians as required.

Skills

Verbal & written communication

Analytical interpretation

Utilization management

Conflict resolution

Project collaboration

Leadership

Education

MD or DO degree

Board Certification in ABMS specialty

Active medical license (at least one jurisdiction)

Willingness to obtain additional license

Job description

Humana Inc. is seeking a Medical Director to oversee preauthorization decisions, utilizing medical judgment to determine appropriate services, levels of care, and sites of service in a regulatory-compliant framework.

You will analyze complex clinical data, review records, and collaborate with care teams to ensure timely and accurate determinations. Remote work within the contiguous US is supported, with travel as needed.