Remote Medical Director: Utilization & Care Leadership

Humana Inc; Montgomery (AL); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana Inc. seeks a Medical Director to review medical necessity and authorize services, ensuring alignment with national guidelines, CMS requirements, and Humana policies. You will assess complex clinical scenarios, review records, and communicate decisions to internal teams.

This remote role emphasizes collaboration, governance, and adherence to regulatory standards. Requirements include an MD or DO, 5+ years of direct clinical care, board certification, and an active license with willingness

Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care post residency or fellowship.
• Board Certification from ABMS or AOA.
• Current, unrestricted medical license in at least one jurisdiction.
• Willingness to obtain additional licenses.
• No current sanctions and pass credentialing requirements.
• Analytic and interpretation skills with experience in quality and utilization management.
• Knowledge of managed care including Medicare Advantage and Medicaid.
• Utilization management experience in a medical management org.
• Experience with national guidelines like MCG or InterQual.
• Clinical specialists in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine.

Responsibilities

• Provide medical interpretations and determinations against guidelines, CMS requirements, and Humana policies.
• Collaborate with teams and Humana colleagues; participate in mentored training and daily work.
• Support dispute and appeals reviews.

Skills

MD/DO

Board Certification

Medical license

Clinical decision making

Utilization management

Education

MD or DO degree

Job description

Humana Inc. seeks a Medical Director to review medical necessity and authorize services, ensuring alignment with national guidelines, CMS requirements, and Humana policies. You will assess complex clinical scenarios, review records, and communicate decisions to internal teams.

This remote role emphasizes collaboration, governance, and adherence to regulatory standards. Requirements include an MD or DO, 5+ years of direct clinical care, board certification, and an active license with willingness