Remote Medical Director – Utilization & Care Leadership

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

Job summary

Humana, Inc. is seeking a Medical Director to leverage medical expertise in evaluating services against national guidelines and CMS requirements.

The role involves remote work across the contiguous USA, with typical 8am–5pm Central hours and occasional travel for training or meetings. Responsibilities include utilization management, documentation review, and collaboration with Humana teams to improve quality and cost outcomes.

Qualifications

• MD or DO degree required.
• 5+ years of direct clinical patient care post-residency/fellowship.
• Board Certification in an ABMS medical specialty.
• Current Louisiana and Oklahoma licenses, or ability to obtain additional licenses without conditions.

Responsibilities

• Provide medical interpretation and determinations for services per national guidelines, CMS, Humana policies, and clinical standards.
• Collaborate with team members and Humana colleagues; after mentoring, perform daily work with minimal direction.
• Support market-wide objectives and community relations; participate in utilization management and care coordination as assigned.

Skills

Clinical decision making

Verbal and written communication

Utilization management

Conflict resolution

Education

MD or DO degree

Board Certification (ABMS)

US license eligibility (LA/OK)

Job description

Humana, Inc. is seeking a Medical Director to leverage medical expertise in evaluating services against national guidelines and CMS requirements.

The role involves remote work across the contiguous USA, with typical 8am–5pm Central hours and occasional travel for training or meetings. Responsibilities include utilization management, documentation review, and collaboration with Humana teams to improve quality and cost outcomes.