Remote Medical Director – Utilization & Care Management

Humana, Inc.; Augusta (ME); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Medical, dental and vision benefits

401(k) retirement plan

Paid time off

Job summary

Humana, Inc. is seeking a Medical Director to review medical claims and determine authorization levels, leveraging CMS guidelines and Humana policies.

The role focuses on inpatient and post-acute settings, requires clinical leadership and collaboration with regional teams in a fully remote US-based setup. Responsibilities include medical interpretation, utilization management, and occasional care-management discussions.

Qualifications

• MD or DO degree required.
• Current ABMS board certification in a medical specialty.
• Excellent verbal and written communication skills.
• Analytic and interpretation skills for utilization management and quality improvement.

Responsibilities

• Provide medical interpretation and determinations for services with respect to national guidelines and Humana policies.
• Collaborate with regional teams and Humana colleagues to support regional market priorities.
• Conduct Utilization Management of care for members in assigned markets.
• Participate in grievance and appeals reviews when needed.
• Engage in project teams or organizational committees as required.

Skills

Verbal communication

Written communication

Analytic interpretation

Team collaboration

Education

MD or DO degree

ABMS board certification

Job description

Humana, Inc. is seeking a Medical Director to review medical claims and determine authorization levels, leveraging CMS guidelines and Humana policies.

The role focuses on inpatient and post-acute settings, requires clinical leadership and collaboration with regional teams in a fully remote US-based setup. Responsibilities include medical interpretation, utilization management, and occasional care-management discussions.