Remote Medical Director - Medicare & Utilization Review

Humana; Saint Paul (MN); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical, dental & vision benefits

401(k) retirement plan

Paid time off

Short/long-term disability

Life insurance

Job summary

Humana, Inc. is seeking a Medical Director to review medical necessity and determine whether services meet national guidelines, CMS requirements and Humana policies.

The role emphasizes data-driven decisions and collaboration with regional leadership in a fully remote setting across the contiguous United States. The position requires an MD or DO, board certification, and 5+ years of direct clinical experience, plus strong communication and analytic skills.

Qualifications

• MD or DO physician qualification required.
• 5+ years of direct clinical patient care experience post residency or fellowship.
• Board Certification in an approved ABMS Medical Specialty.
• Current Louisiana and Oklahoma licenses, or ability to obtain additional licenses without conditions.
• Excellent verbal and written communication skills.
• Experience with utilization management, case management, discharge planning or post-acute services.

Responsibilities

• Provide medical interpretation and determinations that services meet national guidelines, CMS requirements, Humana policies and clinical standards.
• Collaborate with team members, regional leadership and corporate medical director.
• Complete mentored training and then perform daily work with minimal direction.
• Support market-wide objectives and community relations, including Humana's Bold Goal.
• Conduct Utilization Management of care for members in assigned markets and populations.
• Engage in grievance and appeals reviews as needed.

Skills

Verbal communication

Written communication

Analytical skills

Credentialing knowledge

Education

MD or DO degree

Job description

Humana, Inc. is seeking a Medical Director to review medical necessity and determine whether services meet national guidelines, CMS requirements and Humana policies.

The role emphasizes data-driven decisions and collaboration with regional leadership in a fully remote setting across the contiguous United States. The position requires an MD or DO, board certification, and 5+ years of direct clinical experience, plus strong communication and analytic skills.