Remote Medical Director, Utilization & Care Leadership

Humana, Inc.; Lincoln (NE); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Health benefits

Paid time off

Job summary

Humana, Inc. in the United States seeks a Medical Director to oversee medical review and utilization management for inpatient and post-acute services within a regulatory framework.

Excellent clinical background with 5+ years of direct patient care, ABMS board certification, and current licenses. This remote opportunity requires CST hours, strong communication, and collaboration across markets to support Bold Goal and population health initiatives.

Qualifications

• MD or DO degree and board certification in an approved ABMS specialty.
• 5+ years of direct clinical patient care post residency or fellowship.
• Current Louisiana and Oklahoma licenses, with ability to obtain additional licenses.
• No current sanctions; able to pass credentialing requirements.
• Must work 8am-5pm Central Standard Time.
• Excellent verbal and written communication skills.
• Experience in quality, utilization, case management, discharge planning or post-acute services.

Responsibilities

• Provide medical interpretation and determinations against national guidelines, CMS requirements and Humana policies.
• Collaborate with team members, departments, and regional leadership.
• Perform Utilization Management for member care in assigned markets.
• Engage in grievance and appeals reviews when needed.
• Possibly participate on project teams or organizational committees.

Skills

Verbal communication

Written communication

Analytical skills

Leadership

Team collaboration

Education

MD or DO degree

Job description

Humana, Inc. in the United States seeks a Medical Director to oversee medical review and utilization management for inpatient and post-acute services within a regulatory framework.

Excellent clinical background with 5+ years of direct patient care, ABMS board certification, and current licenses. This remote opportunity requires CST hours, strong communication, and collaboration across markets to support Bold Goal and population health initiatives.