Remote Medical Director, Payment Integrity & Analytics

Humana Inc; United States; Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Parental leave

Job summary

Humana Inc. is seeking a Medical Director to review inpatient and post-acute cases, applying national guidelines, CMS requirements, and Humana policies. You will interpret medical records, determine authorization decisions, and communicate outcomes to internal teams.

This remote position may involve occasional peer discussions with external providers. The role emphasizes compliance, clinical judgment, and collaboration with the Lead Medical Director, with mentored training and a focus on quality

Qualifications

• MD or DO currently licensed and able to obtain others.
• 5+ years of direct clinical patient care.
• Active ABMS board certification in a medical specialty.
• Unrestricted license and able to credential.
• Excellent verbal and written communication skills.
• Experience with quality/utilization/case management.

Responsibilities

• Interpret medical necessity and determine service authorization at inpatient level.
• Collaborate with team and Lead Medical Director; mentor after training.
• Ensure compliance with guidelines, CMS requirements, and policies.

Skills

Excellent communication

Analytic skills

Education

MD/DO degree

ABMS Board Certification

Job description

Humana Inc. is seeking a Medical Director to review inpatient and post-acute cases, applying national guidelines, CMS requirements, and Humana policies. You will interpret medical records, determine authorization decisions, and communicate outcomes to internal teams.

This remote position may involve occasional peer discussions with external providers. The role emphasizes compliance, clinical judgment, and collaboration with the Lead Medical Director, with mentored training and a focus on quality