Remote Medical Director — Inpatient Utilization & Care

Humana Inc; Olympia (WA); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana Inc. is seeking a Medical Director to perform medical interpretation and determinations for inpatient services, ensuring compliance with national guidelines, CMS requirements, and Humana policies.

The role involves independent daily work after mentored training and collaboration with Humana colleagues and departments. The position supports market-wide objectives, with travel to Humana offices occasionally.

Qualifications

• MD or DO degree and active license in at least one jurisdiction.
• Board Certification in an approved ABMS Medical Specialty.
• Minimum 5+ years of direct clinical patient care post residency/fellowship.
• No current sanctions from federal or state government agencies; able to credential.

Responsibilities

• Provide medical interpretation and determinations ensuring services align with national guidelines, CMS requirements, and Humana policies.
• Collaborate with team members and Lead Medical Director; operate with trained independence.
• Conduct post-service inpatient care reviews for accurate billing and quality oversight; participate in disputes and appeals as needed.

Skills

Excellent communication

Analytic interpretation

Team collaboration

Education

MD or DO degree

Board Certification ABMS

Active medical license

Job description

Humana Inc. is seeking a Medical Director to perform medical interpretation and determinations for inpatient services, ensuring compliance with national guidelines, CMS requirements, and Humana policies.

The role involves independent daily work after mentored training and collaboration with Humana colleagues and departments. The position supports market-wide objectives, with travel to Humana offices occasionally.