Remote Medical Director: Utilization & Care Leadership

Humana; United States; Remote; USD 224,000 - 313,000; Full time

Job summary

Humana is seeking a Medical Director to apply medical expertise and regulatory knowledge to authorize services and support care decisions in a remote, national setting.

You will review complex cases, coordinate with internal teams, and participate in quality and care management initiatives, with mentoring during onboarding and ongoing collaboration with case managers in various care environments.

Qualifications

• MD or DO degree with board certification required.
• 5+ years of direct clinical patient care post residency or fellowship.
• Active medical license in at least one jurisdiction and willingness to obtain more.

Responsibilities

• Conduct medical interpretation and determinations for services against guidelines and CMS requirements.
• Collaborate with teams and participate in mentored training transitioning to daily work.
• Engage in utilization management and possible dispute/appeals reviews.

Skills

MD/DO background

Clinical review experience

Utilization management

Education

MD or DO degree

Board Certification (ABMS/AOA)

Medical license (any jurisdiction)

Job description

Humana is seeking a Medical Director to apply medical expertise and regulatory knowledge to authorize services and support care decisions in a remote, national setting.

You will review complex cases, coordinate with internal teams, and participate in quality and care management initiatives, with mentoring during onboarding and ongoing collaboration with case managers in various care environments.