Remote Medical Director - Utilization & Care Leadership

Humana, Inc.; Cheyenne (WY); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Remote work

Bonus incentive plan

Job summary

Humana, Inc. seeks a Medical Director to apply medical expertise in determining service authorization, guided by national guidelines and CMS requirements. The role emphasizes collaboration with internal teams, regulatory compliance, and participation in care management across inpatient and post-acute settings.

The position supports Humana’s Bold Goal and value-based care initiatives, with a fully remote arrangement for the contiguous USA and periodic travel for training or meetings.

Qualifications

• MD or DO degree required, board-certified in a medical specialty.
• Active medical licenses in Louisiana and Oklahoma or ability to obtain.
• 5+ years of direct clinical patient care post residency or fellowship.
• Strong verbal and written communication skills; compliance-focused.

Responsibilities

• Provide medical interpretation and determinations per guidelines and policies.
• Collaborate with team members, Humana colleagues, and regional leadership.
• Perform utilization management and contribute to quality initiatives.
• Engage in grievance and appeals processes when applicable.
• Participate in project teams or organizational committees as needed.

Education

MD or DO degree

ABMS board certification

Active Louisiana license

Active Oklahoma license or eligible

Job description

Humana, Inc. seeks a Medical Director to apply medical expertise in determining service authorization, guided by national guidelines and CMS requirements. The role emphasizes collaboration with internal teams, regulatory compliance, and participation in care management across inpatient and post-acute settings.

The position supports Humana’s Bold Goal and value-based care initiatives, with a fully remote arrangement for the contiguous USA and periodic travel for training or meetings.