Remote Medical Director - Medicare/Medicaid Oversight

Humana; Hartford (CT); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical, dental and vision

401(k) retirement plan

Paid time off

Remote work

Job summary

Humana, Inc. is seeking a Medical Director to oversee Medicare/Medicaid services for Home Health, SNF, DME and related programs, ensuring medical necessity aligns with CMS guidelines and Humana policies.

This remote role requires licensure in at least one state and board certification. You will review clinical cases, support regulatory compliance, participate in call rotations, and contribute to operational improvements while delivering strong consumer experiences.

Qualifications

• MD or DO degree.
• Board certification from ABMS or AOABPS; NBPS certification not accepted.
• Current state license and willingness to obtain licenses as required for the region.
• No sanctions from Federal or State authorities.
• At least 5 years of direct clinical patient care post-residency/fellowship.
• Ability to pass credentialing requirements.
• Proficiency with Microsoft Office and Internet navigation.
• Strong verbal and written communication with data interpretation.
• Adaptable and eager to learn new technologies.

Responsibilities

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

Skills

Strong communication

Microsoft Office

Credentialing knowledge

Education

MD or DO degree

ABMS/AOABPS board certification

State medical license

Job description

Humana, Inc. is seeking a Medical Director to oversee Medicare/Medicaid services for Home Health, SNF, DME and related programs, ensuring medical necessity aligns with CMS guidelines and Humana policies.

This remote role requires licensure in at least one state and board certification. You will review clinical cases, support regulatory compliance, participate in call rotations, and contribute to operational improvements while delivering strong consumer experiences.