Remote Medical Director Rehab & Utilization Review

Humana Inc; Santa Fe (NM); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work

Flexible schedule

Job summary

Humana Inc. is seeking a Medical Director to authorize requested services and determine level of care in a remote, US-wide role. You will review complex clinical data, ensure compliance with CMS and Humana guidelines, and guide decisions for post-acute rehabilitation.

The position is full-time with 40 hours weekly, requires MD/DO with board certification and a current medical license, and involves collaboration with clinical leadership, case managers, and external physicians.

Qualifications

• MD or DO degree and board-certified.
• 5+ years clinical experience post-residency.
• Current, unrestricted medical license.
• Experience in inpatient rehab and post-acute care.
• Knowledge of Medicare Advantage and managed care.
• Ability to pass credentialing and avoid sanctions.
• Strong analytic, interpretation, and documentation skills.
• Familiarity with case management and utilization review.

Responsibilities

• Provide medical interpretation and determinations on acute inpatient rehabilitation authorization requests, ensuring alignment with national clinical guidelines, CMS requirements, Humana policies, and clinical standards.
• Collaborate with team members, other departments, Humana colleagues, and clinical leadership to support the review process and facilitate quality outcomes.
• Participate in and complete structured and mentored training programs; utilize ongoing team support during daily work activities.
• Consistently apply critical thinking and maintain high standards in documentation and decision-making within a structured work environment.
• Exercise independence in fulfilling enterprise expectations and meeting compliance timelines.

Skills

Clinical judgment

Analytic skills

Utilization management

Healthcare policy knowledge

Education

MD or DO

Board certification

Medical license

Job description

Humana Inc. is seeking a Medical Director to authorize requested services and determine level of care in a remote, US-wide role. You will review complex clinical data, ensure compliance with CMS and Humana guidelines, and guide decisions for post-acute rehabilitation.

The position is full-time with 40 hours weekly, requires MD/DO with board certification and a current medical license, and involves collaboration with clinical leadership, case managers, and external physicians.