Remote Medical Director – Medicare & Care Management Expert

Humana, Inc.; Austin (TX); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana, Inc. is seeking a Medical Director to apply medical judgment in determinations of services, levels of care, and site of service, reviewing medical records in line with national guidelines and CMS requirements.

The role emphasizes utilization management and collaboration with care teams in a remote, US-wide capacity. The ideal candidate holds an MD or DO, 5+ years of direct clinical care, board certification, and current state licenses.

Qualifications

• MD or DO degree required.
• Board Certification in an approved ABMS Medical Specialty.
• Current Louisiana and Oklahoma licenses or ability to obtain others.
• Excellent verbal and written communication skills.
• Experience with quality/utilization/case management concepts.

Responsibilities

• Provide medical interpretation and determinations aligned with national guidelines and CMS.
• Collaborate with team members and regional leadership to deliver compliant care determinations.
• Participate in adverse event analysis, grievance/appeals as needed.
• Engage with external physicians for data gathering and clarification as required.

Education

MD or DO degree

Board Certification

Licenses (LA, OK)

Excellent verbal and written communication

Analytic and interpretation skills

Job description

Humana, Inc. is seeking a Medical Director to apply medical judgment in determinations of services, levels of care, and site of service, reviewing medical records in line with national guidelines and CMS requirements.

The role emphasizes utilization management and collaboration with care teams in a remote, US-wide capacity. The ideal candidate holds an MD or DO, 5+ years of direct clinical care, board certification, and current state licenses.