Remote Medical Director for Utilization & Care Management

Humana, Inc.; Juneau (AK); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana, Inc. is seeking a Medical Director to review health claims and authorize services in a fully remote role across the contiguous United States. The position requires an MD or DO, board certification, and active licenses, with strong analytic and communication skills.

Working CST hours, occasional travel for training may be involved. You will apply national guidelines (CMS), Humana policies, and utilization management principles, collaborating with regional teams to advance population

Qualifications

• MD or DO degree and active board certification in an ABMS medical specialty.
• Current licenses in Louisiana and Oklahoma or ability to obtain them with no conditions.
• No current sanctions and ability to pass credentialing requirements.
• Strong verbal and written communication skills for collaboration.
• Open to all US territories and able to work CST 8am–5pm.

Responsibilities

• Review medical necessity and determine authorization for services.
• Interpret national guidelines (CMS) and Humana policies in decisions.
• Conduct Utilization Management and participate in care management discussions.
• Communicate decisions to internal associates and external physicians as needed.
• Engage in grievance/appeals reviews and support project teams.

Education

MD or DO degree

Board Certification in a medical specialty

Current Louisiana and Oklahoma licenses

Ability to obtain additional licenses

Excellent verbal and written communication skills

Ability to pass credentialing requirements

Open to all US Territories ( CST 8am-5pm)

Job description

Humana, Inc. is seeking a Medical Director to review health claims and authorize services in a fully remote role across the contiguous United States. The position requires an MD or DO, board certification, and active licenses, with strong analytic and communication skills.

Working CST hours, occasional travel for training may be involved. You will apply national guidelines (CMS), Humana policies, and utilization management principles, collaborating with regional teams to advance population