Remote Medical Director, Outpatient Medicare

Humana Inc; Denver (CO); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Medical, dental, and vision benefits

401(k) retirement plan

Paid time off

Job summary

Humana, Inc. seeks a Medical Director to lead utilization management for complex outpatient Medicare cases. You will apply clinical judgment to determine coverage, level of care, and site of service, guided by CMS guidelines and Humana policies.

The role emphasizes collaboration with physicians, care managers, and internal teams to advance value-based care and quality outcomes. You will work in a structured environment with mentorship, provide input on coding and documentation as it relates to

Qualifications

• MD or DO degree required.
• Board Certification in an ABMS medical specialty.
• Current and unrestricted medical license in at least one jurisdiction.

Responsibilities

• Determine authorization for requested services, level of care, and site of service.
• Perform medical necessity and coverage reviews per CMS requirements and Humana policies.
• Review moderately to complex outpatient cases using submitted documentation.
• Evaluate services against national guidelines and internal policies.
• Prioritize daily case review workload to meet timelines.
• Communicate utilization decisions to internal stakeholders and physicians.

Skills

Communication skills

Analytical skills

Decision-making

Leadership and collaboration

Education

MD or DO degree

ABMS Board Certification

Unrestricted medical license

Job description

Humana, Inc. seeks a Medical Director to lead utilization management for complex outpatient Medicare cases. You will apply clinical judgment to determine coverage, level of care, and site of service, guided by CMS guidelines and Humana policies.

The role emphasizes collaboration with physicians, care managers, and internal teams to advance value-based care and quality outcomes. You will work in a structured environment with mentorship, provide input on coding and documentation as it relates to