Remote Medical Director: Inpatient Utilization Review

Humana, Inc.; Boston (MA); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana, Inc. is seeking a Medical Director to lead inpatient medical necessity reviews, using national guidelines, CMS regulations, and Humana policies to determine care decisions.

The role focuses on complex case analysis, collaboration with physicians, and structured decision-making, with standard hours Monday–Friday and occasional travel for training or meetings. Remote work is supported.

Qualifications

• MD or DO degree with active medical license.
• 5+ years post-residency clinical experience.
• Board certification in AOABPS- or ABMS-recognized specialty and credentialing compliance.

Responsibilities

• Perform expert clinical review of inpatient records to assess medical necessity against guidelines and Humana policies.
• Analyze complex hospital cases and deliver clear utilization management determinations.
• Communicate review outcomes with providers in verbal and written formats.
• Collaborate within a structured team to support high-quality decision-making and physician partnerships.

Skills

Analytical skills

Communication skills

Documentation skills

Team collaboration

Education

MD or DO

Active medical license in at least one state

Board Certification in AOABPS- or ABMS-recognized specialty

Job description

Humana, Inc. is seeking a Medical Director to lead inpatient medical necessity reviews, using national guidelines, CMS regulations, and Humana policies to determine care decisions.

The role focuses on complex case analysis, collaboration with physicians, and structured decision-making, with standard hours Monday–Friday and occasional travel for training or meetings. Remote work is supported.