National Medical Director, Utilization Management (Remote)

Humana Inc; Jackson (MS); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Disability insurance

Life insurance

Job summary

Humana Inc. is seeking a Medical Director to review preauthorization requests and determine appropriate care levels based on national guidelines and CMS policies. The role analyzes complex clinical data, coordinates with internal teams, and may engage in grievance and appeals.

The position emphasizes regulatory compliance and continuous learning about Medicare and Medicare Advantage requirements. This remote role offers travel as needed within the contiguous US, with typical hours Mon–Fri and a

Qualifications

• MD or DO degree required.
• Board certification in an ABMS medical specialty.
• Current unrestricted medical license in at least one state.

Responsibilities

• Provide medical interpretation and determine alignment with guidelines, CMS requirements, Humana policies, and contract terms.
• Collaborate with team members and leadership to communicate decisions.
• Handle daily responsibilities with minimal direction after mentored training.
• Maintain consistent clinical thinking and clearly document determinations.
• Ensure adherence to regulatory timelines.

Skills

Verbal & written communication

Analytical interpretation

Curiosity & adaptability

Independence in work

Education

MD or DO degree

ABMS board certification

Active medical license

Tools

MCG guidelines

InterQual guidelines

Job description

Humana Inc. is seeking a Medical Director to review preauthorization requests and determine appropriate care levels based on national guidelines and CMS policies. The role analyzes complex clinical data, coordinates with internal teams, and may engage in grievance and appeals.

The position emphasizes regulatory compliance and continuous learning about Medicare and Medicare Advantage requirements. This remote role offers travel as needed within the contiguous US, with typical hours Mon–Fri and a