Remote Medical Director: Medicare & Medicaid Compliance

Humana, Inc.; Cheyenne (WY); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Remote work at home

Professional development

Job summary

Humana, Inc. is hiring a Medical Director to evaluate medical necessity for Medicare/Medicaid services and ensure adherence to CMS guidance, state/federal laws, and Humana policies.

The role focuses on regulatory compliance, clinical guidelines, and cross-team collaboration in a remote work environment. The position includes a 40-hour work week with call rotations, potential weekend coverage, and ongoing education.

Qualifications

• MD or DO degree required.
• Active board certification from ABMS/AOABPS; NBPS not accepted.
• Current and unrestricted state license; willingness to obtain others as region requires.

Responsibilities

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

Skills

Microsoft Office

Verbal & written communication

Adaptable to new technologies

Education

MD or DO degree

Board certification (ABMS/AOABPS)

Licensed in at least one state

Tools

Microsoft Office

Job description

Humana, Inc. is hiring a Medical Director to evaluate medical necessity for Medicare/Medicaid services and ensure adherence to CMS guidance, state/federal laws, and Humana policies.

The role focuses on regulatory compliance, clinical guidelines, and cross-team collaboration in a remote work environment. The position includes a 40-hour work week with call rotations, potential weekend coverage, and ongoing education.