Remote Medical Director — Medicare & Compliance

Humana; Denver (CO); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Remote work from home

Bonus incentive plan

Job summary

Humana, Inc. is seeking a Medical Director to oversee clinical determinations for Medicare/Medicaid services across Home Health, SNF, and DME. The role emphasizes medical necessity, CMS guideline interpretation, and regulatory compliance in a remote setting serving multiple states.

The position requires an MD or DO, current state licensure, board certification, 5+ years of direct clinical care, and strong communication skills. Travel is occasional; base pay ranges with bonus eligibility.

Qualifications

• MD or DO degree.
• Current, active medical license in at least one state and eligible for others.
• Board certification by ABMS or AOABPS required.

Responsibilities

• Review clinical cases to determine medical necessity for Medicare/Medicaid members.
• Ensure compliance with policies, procedures, and regulatory standards.
• Apply CMS policies, Medicare requirements and guidelines.
• Identify opportunities for medical management improvements.
• Participate in call rotations and after-hours coverage.

Skills

Communication skills

Clinical judgment

Regulatory knowledge

Education

MD/DO degree

Tools

Microsoft Office

Internet navigation

Job description

Humana, Inc. is seeking a Medical Director to oversee clinical determinations for Medicare/Medicaid services across Home Health, SNF, and DME. The role emphasizes medical necessity, CMS guideline interpretation, and regulatory compliance in a remote setting serving multiple states.

The position requires an MD or DO, current state licensure, board certification, 5+ years of direct clinical care, and strong communication skills. Travel is occasional; base pay ranges with bonus eligibility.