Remote Medical Director: Utilization & Care

Humana, Inc.; Boise (ID); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work

Job summary

Humana, Inc. is seeking a Medical Director to provide medical interpretation and determinations on services in alignment with national guidelines and CMS requirements. The role emphasizes collaboration with internal teams and regional leadership in a remote, nationwide setting.

Responsibilities include utilization management, care management support, and potential participation in grievances and appeals. Strong clinical judgment and communication are essential for success in a fast-paced,

Qualifications

• MD or DO degree is required.
• Board certification in ABMS medical specialty.
• Active medical license in Louisiana and/or Oklahoma, or ability to obtain.
• US territory eligibility; 8am–5pm CST work hours.
• Excellent verbal and written communication skills.
• Experience in utilization management and quality improvement.
• Familiarity with CMS guidelines and national standards.

Responsibilities

• Provide medical interpretation and determinations on service authorization per guidelines.
• Collaborate with Humana colleagues and regional leadership.
• Communicate decisions to internal associates and participate in mentored training.
• Engage in grievance and appeals reviews as needed.
• Participate on project teams or committees and support market priorities.

Skills

Verbal communication

Written communication

Analytical thinking

Decision making

Education

MD or DO degree

Board Certification (ABMS)

Medical license (LA/OK)

Job description

Humana, Inc. is seeking a Medical Director to provide medical interpretation and determinations on services in alignment with national guidelines and CMS requirements. The role emphasizes collaboration with internal teams and regional leadership in a remote, nationwide setting.

Responsibilities include utilization management, care management support, and potential participation in grievances and appeals. Strong clinical judgment and communication are essential for success in a fast-paced,