Remote Medical Director: Medicare & Care Management

Humana, Inc.; Concord (NH); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work

Job summary

Humana, Inc. seeks a Medical Director to review health claims, determine service authorization, and apply clinical judgment across inpatient and post-acute settings. You will work within CMS and Humana guidelines, coordinating with internal teams to support Bold Goal initiatives.

Roles require a medical degree, Board Certification, and licensure in LA/OK with willingness to obtain others. The position offers a fully remote setup with occasional travel and a standard 40-hour week.

Qualifications

• MD or DO with 5+ years of direct clinical care experience post residency or fellowship.
• Board Certification in an ABMS-recognized specialty.
• Current Louisiana and Oklahoma licenses, and ability to obtain others.

Responsibilities

• Provide medical interpretation and determinations per national guidelines, CMS, and Humana policies.
• Coordinate with Regional VP Health Services and other teams to support market priorities.
• Mentor/train staff and ensure compliance timelines and clinical standards.
• Engage in grievance and appeals when appropriate; contribute to project teams as needed.

Skills

Leadership

Communication

Utilization management

Collaboration

Analytical thinking

Education

MD/DO degree

Board Certification (ABMS)

Medical Licenses (LA, OK)

Tools

MCG/InterQual familiarity

Job description

Humana, Inc. seeks a Medical Director to review health claims, determine service authorization, and apply clinical judgment across inpatient and post-acute settings. You will work within CMS and Humana guidelines, coordinating with internal teams to support Bold Goal initiatives.

Roles require a medical degree, Board Certification, and licensure in LA/OK with willingness to obtain others. The position offers a fully remote setup with occasional travel and a standard 40-hour week.