Remote Medical Director - Inpatient Utilization Review

Humana, Inc.; United States; Remoto; USD 224.000 - 313.000; Tempo integral

Benefícios oferecidos por esta vaga

Bonus incentive plan

Resumo da vaga

Humana, Inc. is seeking a Medical Director for inpatient review to join a remote nationwide team.

You will perform expert clinical reviews of inpatient records, determine medical necessity based on CMS, Humana policies, and national guidelines, and deliver clear decisions. Ideal candidates have 5+ years post-residency, an active medical license, ABMS/AOABPS board certification, and strong analytical and communication skills to collaborate with providers and multidisciplinary teams.

Qualificações

• MD or DO with current unrestricted license in at least one state.
• 5+ years post-residency clinical experience.
• Board Certification in AOABPS- or ABMS-recognized specialty.
• Meets credentialing requirements with no sanctions.
• Strong analytical, communication, and documentation skills.
• Able to work in a structured, multidisciplinary team.

Responsabilidades

• Perform inpatient medical necessity reviews based on guidelines and Humana policies.
• Analyze complex hospital-based cases and provide clear determinations.
• Communicate review outcomes with external providers via phone and written format.
• Collaborate with team to support quality and consistency.
• Support educational content and process improvements.

Conhecimentos

Analytical thinking

Communication skills

Team collaboration

Documentation skills

Utilization management

Formação

MD or DO

Ferramentas

MCG/InterQual guidelines

Descrição da vaga

Humana, Inc. is seeking a Medical Director for inpatient review to join a remote nationwide team.

You will perform expert clinical reviews of inpatient records, determine medical necessity based on CMS, Humana policies, and national guidelines, and deliver clear decisions. Ideal candidates have 5+ years post-residency, an active medical license, ABMS/AOABPS board certification, and strong analytical and communication skills to collaborate with providers and multidisciplinary teams.