Remote Medical Director — Rehab Utilization & Medicare

Humana Inc; Phoenix (AZ); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Medical Director to determine authorization for services, level of care, and site of service within Medicare/Medicare Advantage guidelines.

Involves review of clinical records, discussions with external physicians, and ongoing training in a remote, nationwide capacity. The role requires an MD or DO, 5+ years of post-residency clinical experience (preferably inpatient rehab), board certification, and an active license.

Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care experience post residency or fellowship, including inpatient rehab exposure.
• Board Certified in an ABMS/AOA specialty with continued certification.
• Active license in at least one jurisdiction.
• No current sanction from Federal or State Governmental organizations; able to pass credentialing.
• Experience in quality management, utilization management, and acute inpatient rehabilitation.
• Knowledge of Medicare Advantage, Managed Medicaid, or other medical management organizations.
• Utilization management experience in a medical management review organization.
• Specialty areas: PM&R, Internal Medicine, Family Practice, Geriatrics, or Hospitalist.

Responsibilities

• Provide medical interpretation and determinations on authorization requests for acute inpatient rehabilitation.
• Collaborate with team members and clinical leadership to support the review process and ensure quality outcomes.
• Participate in structured and mentored training programs; utilize team support during daily work.
• Maintain high standards of documentation and decision-making in a structured environment.
• Exercise independence to meet enterprise expectations and compliance timelines.
• Work is full-time remote with a 40-hour schedule; may be performed from anywhere in the United States.

Skills

Analytic skills

Interpretation skills

Utilization management experience

Quality management experience

Education

MD or DO degree

Board Certified in ABMS/AOA specialty

Current unrestricted license

Job description

Humana Inc. is seeking a Medical Director to determine authorization for services, level of care, and site of service within Medicare/Medicare Advantage guidelines.

Involves review of clinical records, discussions with external physicians, and ongoing training in a remote, nationwide capacity. The role requires an MD or DO, 5+ years of post-residency clinical experience (preferably inpatient rehab), board certification, and an active license.