Remote Medical Director – Medicare/Medicaid Oversight

Humana; Trenton (NJ); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Comprehensive benefits package

Job summary

Humana, Inc. is seeking a Medical Director to oversee Medicare/Medicaid cases for Home Health, SNF, DME, and related services. You will assess medical necessity, ensure regulatory and Humana policy alignment, and guide clinical decision-making across states in the region.

Responsibilities include reviewing cases, applying CMS guidelines, and collaborating with leadership. Remote work with occasional travel to Humana offices may be required; strong communication and credentialing readiness are

Qualifications

• MD or DO degree.
• ABMS or AOABPS board certification; NBPAS not accepted.
• Active state medical license and willingness to obtain others in region.
• No sanctions from federal or state agencies.
• 5 years of direct clinical patient care post residency/fellowship.
• Ability to pass credentialing requirements.
• Strong Microsoft Office and Internet navigation skills.
• Excellent verbal and written communication; ability to analyze data clearly.

Responsibilities

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

Skills

Verbal communication

Written communication

Analytical thinking

Adaptable to new technologies

Education

MD or DO degree

ABMS/AOABPS board certification

Active medical license in at least one state

Credentialing readiness

Tools

Microsoft Office

Internet navigation

Job description

Humana, Inc. is seeking a Medical Director to oversee Medicare/Medicaid cases for Home Health, SNF, DME, and related services. You will assess medical necessity, ensure regulatory and Humana policy alignment, and guide clinical decision-making across states in the region.

Responsibilities include reviewing cases, applying CMS guidelines, and collaborating with leadership. Remote work with occasional travel to Humana offices may be required; strong communication and credentialing readiness are