Remote Inpatient Utilization Medical Director

Humana Inc; Austin (TX); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement plan

Paid time off

Disability insurance

Life insurance

Job summary

Humana Inc. in the United States seeks a Medical Director to perform expert inpatient medical record reviews and assess medical necessity based on national guidelines, CMS regulations, Humana policies, and recognized clinical standards.

This remote, full‑time role emphasizes collaboration within a multidisciplinary team, data‑driven decision making, and high‑quality patient outcomes, with standard hours M–F 8am–5pm local time and occasional travel.

Qualifications

• MD or DO degree required.
• 5+ years post-residency clinical experience.
• Active, unrestricted medical license in at least one state.
• 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

• Conduct inpatient medical necessity reviews promptly per regulatory requirements.
• Communicate review outcomes clearly in verbal and written formats.
• Uphold productivity, accuracy, quality, and timely completion.
• Adapt to changing workflows and utilization procedures.

Skills

MD/DO

5+ years experience

Medical license

Board certification

Credentialing

Analytical skills

Communication

Documentation

Team player

Education

MD or DO degree

Job description

Humana Inc. in the United States seeks a Medical Director to perform expert inpatient medical record reviews and assess medical necessity based on national guidelines, CMS regulations, Humana policies, and recognized clinical standards.

This remote, full‑time role emphasizes collaboration within a multidisciplinary team, data‑driven decision making, and high‑quality patient outcomes, with standard hours M–F 8am–5pm local time and occasional travel.