Remote Medical Director, Medicare & Care Management

Humana, Inc.; Columbus (OH); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Disability insurance

Life insurance

Job summary

Humana Inc. is seeking a Medical Director for a fully remote role to oversee medical determinations with an emphasis on Medicare Advantage and related care management.

You will interpret clinical data, ensure alignment with national guidelines, and collaborate with internal teams and contracted physicians to drive appropriate care decisions. The role requires board certification, active medical licensure, and 5+ years of clinical experience, with occasional travel to Humana offices for training

Qualifications

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

Responsibilities

• Review preauthorization requests for services.
• Provide medical interpretation and determinations per national guidelines and CMS requirements.
• Communicate decisions to internal associates and participate in care management when applicable.
• Collaborate with Humana colleagues and external physicians as needed.

Skills

MD or DO degree

Board Certification in ABMS/AOA

Active medical license

Excellent communication

Analytic interpretation

Willing to travel

Education

MD or DO

Board Certification

Job description

Humana Inc. is seeking a Medical Director for a fully remote role to oversee medical determinations with an emphasis on Medicare Advantage and related care management.

You will interpret clinical data, ensure alignment with national guidelines, and collaborate with internal teams and contracted physicians to drive appropriate care decisions. The role requires board certification, active medical licensure, and 5+ years of clinical experience, with occasional travel to Humana offices for training