Remote Medical Director, PI & Claims Appeals

Humana Inc; Helena (MT); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work possible

Occasional travel

Job summary

Humana, Inc. is seeking a Medical Director to review and authorize services in accordance with national guidelines, CMS requirements, and Humana policies.

The role involves evaluating clinical records, discussing determinations with internal teams, and potentially engaging in care management across inpatient, outpatient, and post-acute settings. The position is remote, with travel as needed, and requires 5+ years of direct clinical patient care post-residency, board certification, and licensure

Qualifications

• MD or DO degree required.
• Board Certification in an approved ABMS or AOA medical specialty.
• Licensed in at least one jurisdiction and willing to obtain additional licenses.
• Experience in quality management, utilization management, case management, discharge planning, or post-acute services.

Responsibilities

• Provide medical interpretation and determinations for service authorization.
• Collaborate with team members, other departments, and Humana colleagues.
• Perform daily work after mentored training.
• Contribute to dispute and appeals reviews as needed.

Skills

Clinical review

Utilization management

Medical policy interpretation

Education

MD or DO degree

Board Certification ABMS/AOA

Job description

Humana, Inc. is seeking a Medical Director to review and authorize services in accordance with national guidelines, CMS requirements, and Humana policies.

The role involves evaluating clinical records, discussing determinations with internal teams, and potentially engaging in care management across inpatient, outpatient, and post-acute settings. The position is remote, with travel as needed, and requires 5+ years of direct clinical patient care post-residency, board certification, and licensure