Remote Medical Director: Inpatient Utilization & Review

Humana Inc; Charleston (WV); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana Inc. seeks a Medical Director to perform expert inpatient medical necessity reviews, relying on CMS regulations, Humana policies, and established clinical standards.

You will analyze complex hospital cases and present clear utilization determinations, communicating outcomes to providers and collaborating in a professional team environment. This remote role requires a physician with 5+ years post-residency experience, unrestricted licensure, and board certification.

Qualifications

• MD or DO with 5+ years post-residency clinical experience.
• Active, unrestricted medical license in at least one state and willingness to obtain more licenses.
• Board certification in an AOABPS- or ABMS-recognized specialty.
• Strong analytical, communication, and documentation skills.

Responsibilities

• Perform inpatient medical necessity reviews according to guidelines and policies.
• Analyze complex hospital cases and provide clear utilization determinations.
• Communicate review outcomes with providers verbally and in writing.
• Collaborate within a structured, multidisciplinary team.

Skills

MD/DO experience

Post-residency experience

Analytical communication

Team collaboration

Education

MD/DO degree

Board Certification AOABPS/ABMS

Job description

Humana Inc. seeks a Medical Director to perform expert inpatient medical necessity reviews, relying on CMS regulations, Humana policies, and established clinical standards.

You will analyze complex hospital cases and present clear utilization determinations, communicating outcomes to providers and collaborating in a professional team environment. This remote role requires a physician with 5+ years post-residency experience, unrestricted licensure, and board certification.