Remote Medical Director, Medicare Compliance & Care

Humana; Helena (MT); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Remote work at home

40-hour work week

EST onboarding training

Travel for training

Job summary

Humana, Inc. invites a Medical Director to oversee Medicare/Medicaid services, ensure medical necessity, and align care with CMS guidelines and contracts. This remote-friendly leadership position requires licensure in at least one state and ABMS/AOABPS board certification.

The role emphasizes regulatory compliance, clinical governance, and collaboration with the OneHome leadership, with scheduled hours and travel as needed to support training and meetings.

Qualifications

• MD or DO degree.
• ABMS or AOABPS board certification; NBPA S not accepted.
• Current, active state medical license and willingness to obtain others.
• No sanctions from federal or state authorities.
• 5 years of direct clinical patient care post residency.
• Ability to pass credentialing requirements.
• Proficient with Microsoft Office and Internet navigation.
• Strong verbal and written communication skills.
• Adaptable and quick to learn new technologies.

Responsibilities

• Review clinical cases and determine medical necessity for Medicare/Medicaid.
• Ensure compliance with policies, procedures, and regulatory standards.
• Apply CMS policies and Medicare/Medicaid requirements.
• Identify opportunities for medical management improvements.
• Participate in call rotations, including weekend coverage and after-hours coverage.
• Contribute to collaborative team culture and exceptional consumer experiences.
• Participate in educational activities and create content to present for subject matter contribution.
• Support Home Solutions and other activities as assigned by leadership.

Skills

Verbal communication

Written communication

Regulatory compliance

Credentialing process

Adaptability

Education

MD or DO degree

Tools

Microsoft Office

Job description

Humana, Inc. invites a Medical Director to oversee Medicare/Medicaid services, ensure medical necessity, and align care with CMS guidelines and contracts. This remote-friendly leadership position requires licensure in at least one state and ABMS/AOABPS board certification.

The role emphasizes regulatory compliance, clinical governance, and collaboration with the OneHome leadership, with scheduled hours and travel as needed to support training and meetings.