Remote Medical Director: Medicare & Care Utilization

Humana Inc; Montpelier (VT); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. seeks a Medical Director to review clinical scenarios, interpret records, and authorize inpatient services in alignment with national guidelines and CMS requirements. The role involves collaboration with peers, mentors, and multiple Humana teams to ensure compliant, high-quality care.

After mentored training, you will handle complex cases, contribute to quality management, and participate in disputes and appeals as needed, while supporting market-wide goals and community relations.

Qualifications

• MD or DO degree and board certification.
• Current, unrestricted medical license in at least one jurisdiction.
• No sanctions from federal or state agencies; credentialing passed.
• Excellent verbal and written communication skills.
• Experience in quality/utilization management and post-acute care settings.

Responsibilities

• Provide medical interpretation and determinations ensuring services meet national guidelines and CMS requirements.
• Collaborate with team, Lead Medical Director, and other departments.
• After mentored training, perform daily work with minimal direction and maintain compliance timings.
• Support market-wide objectives and community relations as directed.

Skills

Verbal & written communication

Analytic skills

Utilization management

Medicare/Medicaid knowledge

Inpatient care exp

Team collaboration

Education

MD/DO degree

ABMS board certification

Active medical license

MBA/MHA/MPH

Job description

Humana Inc. seeks a Medical Director to review clinical scenarios, interpret records, and authorize inpatient services in alignment with national guidelines and CMS requirements. The role involves collaboration with peers, mentors, and multiple Humana teams to ensure compliant, high-quality care.

After mentored training, you will handle complex cases, contribute to quality management, and participate in disputes and appeals as needed, while supporting market-wide goals and community relations.