Remote Medical Director — Acute Rehab & Utilization

Humana Inc; Juneau (AK); À distance; USD 224 000 - 313 000; Plein temps

Résumé du poste

Humana Inc. is seeking a Medical Director to authorize services and determine level of care within Medicare/Medicaid contexts.

The role emphasizes utilization management, regulatory compliance, and collaboration with clinical leadership, with daily review of complex cases and discussions with external physicians as needed. The position is fully remote, requires 40 hours weekly, and may involve occasional travel to Humana offices for training or meetings.

Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care after residency/fellowship, preferably inpatient acute rehab.
• Board Certified in an ABMS/AOA specialty with ongoing certification.
• Current, unrestricted license in at least one jurisdiction; willingness to obtain more.
• No sanctions; able to pass credentialing requirements.
• Analytic/interpretation skills; experience in quality/utilization management.
• Knowledge of Medicare Advantage/Medicaid and medical management organizations.
• Utilization management experience in a medical management org.
• Background in PM&R, Internal Medicine, Family Practice, Geriatrics, or Hospitalist.

Responsabilités

• Provide medical interpretation and determinations on acute inpatient rehabilitation authorization requests.
• Collaborate with teams and leadership to support review processes and quality outcomes.
• Participate in structured and mentored training; utilize team support.
• Maintain high standards in documentation and decision-making within a structured environment.
• Exercise independence to meet enterprise expectations and compliance timelines.
• This is a full-time remote role; 40 hours per week; may work from anywhere in the United States.

Connaissances

Analytic thinking

Decision making

Regulatory compliance

Communication

Collaboration

Formation

MD or DO

Board Certification

Active medical license

MBA/MHA/ MPH (preferred)

Description du poste

Humana Inc. is seeking a Medical Director to authorize services and determine level of care within Medicare/Medicaid contexts.

The role emphasizes utilization management, regulatory compliance, and collaboration with clinical leadership, with daily review of complex cases and discussions with external physicians as needed. The position is fully remote, requires 40 hours weekly, and may involve occasional travel to Humana offices for training or meetings.