Remote Medical Director — Utilization & Care Leadership

Humana Inc; Little Rock (AR); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Remote work

Job summary

Humana Inc. is seeking a Medical Director for a remote role focused on medical interpretation and determinations of services in alignment with national guidelines, CMS requirements, and Humana policies.

The position involves review of clinical records, coordination with multidisciplinary teams, and participation in quality and utilization management initiatives across inpatient, outpatient, or post-acute settings.

Qualifications

• MD or DO degree required.
• Current and ongoing Board Certification by ABMS or AOA.
• Active medical license in at least one jurisdiction, with willingness to obtain additional licenses.

Responsibilities

• Provide medical interpretation and determinations for services per national guidelines, CMS requirements, Humana policies, and clinical standards.
• Collaborate with team members and departments; participate in mentored training before independent daily work.
• Engage in utilization management, care coordination, and post-acute services as applicable.
• Discuss with physicians and internal groups to support organizational priorities and value-based care.

Skills

MD/DO

Board Certification

Medical License

Clinical Experience

Utilization Management

Internal Medicine/Family/Geriatrics/HM

Emergency Medicine

Education

MD or DO degree

Job description

Humana Inc. is seeking a Medical Director for a remote role focused on medical interpretation and determinations of services in alignment with national guidelines, CMS requirements, and Humana policies.

The position involves review of clinical records, coordination with multidisciplinary teams, and participation in quality and utilization management initiatives across inpatient, outpatient, or post-acute settings.