Remote Medical Director, Inpatient & Utilization (MD/DO)

Humana Inc; Atlanta (GA); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Medical Director to perform medical determinations on inpatient services and level of care, utilizing national guidelines and CMS requirements.

The role involves reviewing complex clinical scenarios, evaluating records, and collaborating with Humana teams. Some roles may include coding practices and post-acute service oversight, with potential peer discussions with external providers.

Qualifications

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

Responsibilities

• Provide medical interpretation and determinations against guidelines, CMS requirements, Humana policies, and contracts.
• Collaborate with team members and other departments; mentored training followed by independent work.
• Support market-wide objectives and participate in quality and utilization management activities.

Skills

Communication skills

Analytic interpretation

Team collaboration

Education

MD or DO degree

ABMS Board Certification

Unrestricted medical license

Job description

Humana Inc. is seeking a Medical Director to perform medical determinations on inpatient services and level of care, utilizing national guidelines and CMS requirements.

The role involves reviewing complex clinical scenarios, evaluating records, and collaborating with Humana teams. Some roles may include coding practices and post-acute service oversight, with potential peer discussions with external providers.