Remote Medical Director, Inpatient Utilization Review

Humana; Jackson (MS); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work opportunity

Competitive benefits

Job summary

Humana seeks a Medical Director to lead expert clinical reviews of inpatient records, determining medical necessity per CMS, Humana policies, and national guidelines. You will discuss outcomes with external providers and collaborate in a structured team to influence patient care decisions.

Ideal candidates have 5+ years post-residency, an active medical license, and ABMS/AOABPS board certification. Role offers Monday–Friday 8am–5pm in a remote/hybrid setting with a focus on high-quality,

Qualifications

• MD or DO medical degree and board certification.
• 5+ years post-residency clinical experience.
• Active, unrestricted medical license in at least one state.
• Board certification by an AOABPS- or ABMS-recognized specialty.
• Meets credentialing requirements with no sanctions.
• Strong analytical, communication, and documentation skills.
• Ability to work effectively within a structured multidisciplinary team.

Responsibilities

• Perform inpatient medical necessity reviews promptly per regulatory requirements.
• Uphold excellence in productivity, accuracy, quality, and timely completion of tasks.
• Communicate review outcomes clearly in verbal and written formats.
• Collaborate within a structured, team-oriented environment.
• Advance Humana’s mission by supporting consistent decision-making and physician partnerships.

Skills

Analytical thinking

Communication

Documentation

Team collaboration

Education

MD or DO

Board Certification (AOABPS- or ABMS-recognized)

Active medical license in at least one state

Tools

MCG® or InterQual® guidelines

Job description

Humana seeks a Medical Director to lead expert clinical reviews of inpatient records, determining medical necessity per CMS, Humana policies, and national guidelines. You will discuss outcomes with external providers and collaborate in a structured team to influence patient care decisions.

Ideal candidates have 5+ years post-residency, an active medical license, and ABMS/AOABPS board certification. Role offers Monday–Friday 8am–5pm in a remote/hybrid setting with a focus on high-quality,