Remote Medical Director, Utilization & Care Management

Humana Inc; Carson City (NV); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical, dental & vision benefits

401(k) retirement savings plan

Paid time off

Job summary

Humana Inc. is seeking a Medical Director to lead utilization management decisions across inpatient, outpatient, and post-acute settings.

You will apply national guidelines, CMS requirements, and Humana policies to determine appropriate care levels and sites of service, with mentored training and collaboration across teams. The role emphasizes experience in quality and case management, strong analytical skills, and the ability to work in a remote environment with travel as needed.

Qualifications

• MD or DO degree required.
• 5+ years of direct clinical patient care post residency or fellowship.
• Current and ongoing Board Certification in an approved ABMS or AOA specialty.
• Current and unrestricted medical license in at least one jurisdiction and willingness to obtain additional licenses.
• Experience with utilization management, quality management, discharge planning, and post-acute services.

Responsibilities

• Provide medical interpretation and determinations for service appropriateness.
• Collaborate with internal teams to support organizational priorities.
• Perform daily work after mentored training and participate in dispute/appeals reviews as needed.
• Communicate decisions to internal associates and support care management discussions.

Skills

Clinical review

Team collaboration

Communication with physicians

Education

MD or DO degree

Job description

Humana Inc. is seeking a Medical Director to lead utilization management decisions across inpatient, outpatient, and post-acute settings.

You will apply national guidelines, CMS requirements, and Humana policies to determine appropriate care levels and sites of service, with mentored training and collaboration across teams. The role emphasizes experience in quality and case management, strong analytical skills, and the ability to work in a remote environment with travel as needed.