Remote Medical Director: Medicare Utilization & Care

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

Job summary

Humana Inc. is seeking a Medical Director to adjudicate inpatient requests, review clinical records, and ensure compliance with Medicare/Medicaid/Medicare Advantage requirements. You will work with a multidisciplinary team, participate in quality initiatives, and may engage in appeals processes. A mentored training period precedes autonomous duties.

This role emphasizes evidence-based decision making, regulatory adherence, and effective communication across Humana care teams.

Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care experience post residency or fellowship.
• Current ABMS Board Certification in a medical specialty.
• Active license in at least one jurisdiction and ability to obtain others.
• No current sanctions from government or licensing bodies.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills with involvement in quality/utilization/case management.

Responsibilities

• Provide medical interpretation and determinations on inpatient services with respect to guidelines and requirements.
• Collaborate with team members and Lead Medical Director; complete mentored training and operate with consistent authorship.
• Contribute to quality management, utilization management, discharge planning, and post-acute services wherever applicable.
• Engage in disputes/grievance and appeals reviews when needed.

Skills

MD or DO degree

Clinical experience

Board Certification

Medical license

Verbal and written communication

Analytic interpretation

Job description

Humana Inc. is seeking a Medical Director to adjudicate inpatient requests, review clinical records, and ensure compliance with Medicare/Medicaid/Medicare Advantage requirements. You will work with a multidisciplinary team, participate in quality initiatives, and may engage in appeals processes. A mentored training period precedes autonomous duties.

This role emphasizes evidence-based decision making, regulatory adherence, and effective communication across Humana care teams.