Remote Medical Director: Medicare & Compliance

Humana; United States; Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Remote work at home

Bonus incentives

Job summary

Humana is seeking a Medical Director to review clinical cases for Medicare and Medicaid members and determine medical necessity in accordance with CMS guidelines and Humana policies. This remote role requires board certification, active licensure, and the ability to collaborate across teams to ensure compliant, high-quality patient care.

You will participate in ongoing education, contribute to process improvements, and support Home Solutions initiatives while aligning with organizational

Qualifications

• MD or DO degree required.
• Board certification from ABMS or AOABPS required; NBPA S certification not accepted.
• Current state license in at least one state and ability to obtain others as needed.

Responsibilities

• Review medical necessity of services for Medicare/Medicaid members.
• Ensure compliance with policies, procedures, and regulatory standards.
• Apply CMS policies, Medicare/Medicaid requirements.
• Identify opportunities for medical management improvements.
• Participate in call rotations including weekends and after-hours.
• Contribute to a collaborative team culture and exceptional consumer experiences.
• Attend required conferences and contribute educational content.
• Support Home Solutions and other activities as assigned by OneHome leadership.

Skills

Verbal and written communication

Credentialing requirements

Regulatory compliance understanding

Adaptability to new technologies

Education

MD or DO degree

Tools

Microsoft Office

Job description

Humana is seeking a Medical Director to review clinical cases for Medicare and Medicaid members and determine medical necessity in accordance with CMS guidelines and Humana policies. This remote role requires board certification, active licensure, and the ability to collaborate across teams to ensure compliant, high-quality patient care.

You will participate in ongoing education, contribute to process improvements, and support Home Solutions initiatives while aligning with organizational