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 and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Disability and life insurance

Job summary

Humana, Inc. invites a Medical Director to join our remote team serving the contiguous United States. The role emphasizes clinical decision-making, utilization management, and collaboration with regional health services leadership to meet population health goals.

You will review inpatient and post-acute cases, ensure alignment with CMS and Humana guidelines, and participate in ongoing professional development. Travel may be required occasionally for training or meetings.

Qualifications

• MD or DO degree is required.
• Board certification in a recognized medical specialty is required.
• Licenses in good standing in applicable states or the ability to obtain them.
• Experience in utilization management, quality improvement, or care management is preferred.

Responsibilities

• Provide medical interpretation and determinations aligning with national guidelines and CMS requirements.
• Collaborate with Humana colleagues and regional leadership to support market priorities.
• Perform utilization management and participate in grievance/appeals as needed.
• Engage with external physicians for information gathering and conflict resolution as required.

Skills

Verbal and written communication

Analytic and interpretation skills

Team collaboration in quality/Utiliz..

Education

MD or DO degree

ABMS board certification

US licenses or ability to obtain

Job description

Humana, Inc. invites a Medical Director to join our remote team serving the contiguous United States. The role emphasizes clinical decision-making, utilization management, and collaboration with regional health services leadership to meet population health goals.

You will review inpatient and post-acute cases, ensure alignment with CMS and Humana guidelines, and participate in ongoing professional development. Travel may be required occasionally for training or meetings.