Remote Medical Director — Rehab & Utilization Management

Humana Inc; Trenton (NJ); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Comprehensive benefits

Job summary

Humana Inc in the United States is seeking a Medical Director to authorize services and determine level of care for DSNP, leveraging clinical guidelines, CMS policies, and internal standards. This full-time remote role requires MD/DO, 5+ years of post-residency care, board certification, and licensure; you will review clinical records, discuss with external physicians, and ensure compliance.

Travel may be required occasionally.

Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care post residency/fellowship, inpatient rehab preferred.
• Board Certified with ongoing certification.
• Active license in at least one jurisdiction; willing to obtain additional licenses.
• No sanctions; able to pass credentialing requirements.
• Experience in quality management and utilization management.
• Knowledge of Medicare Advantage, Managed Medicaid or similar programs.
• Utilization management experience in a medical management setting.
• Background in PM&R, Internal Medicine, Family Practice, Geriatrics or Hospitalist care.

Responsibilities

• Provide medical interpretation and determinations on authorization requests and level of care.
• Collaborate with cross-functional teams to support the review process and outcomes.
• Participate in training programs and rely on team support during daily work.
• Maintain high-quality documentation and timely decision-making.
• Operate with independence to meet enterprise expectations and compliance timelines.

Skills

Analytic interpretation skills

Utilization management

Team collaboration

Education

MD or DO degree

Board Certification in ABMS or AOA

Job description

Humana Inc in the United States is seeking a Medical Director to authorize services and determine level of care for DSNP, leveraging clinical guidelines, CMS policies, and internal standards. This full-time remote role requires MD/DO, 5+ years of post-residency care, board certification, and licensure; you will review clinical records, discuss with external physicians, and ensure compliance.

Travel may be required occasionally.