Remote Medical Director: Utilization & Care Management

Humana, Inc.; Denver (CO); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana, Inc. is seeking a Medical Director to provide medical interpretation and determinations to ensure services align with national guidelines and CMS requirements. The role emphasizes collaboration with regional health services and Humana colleagues to support value-based care and population health initiatives.

Fully remote in the contiguous USA, with occasional travel for training or meetings. Typical hours are 40 per week, 8am-5pm Central time compatibility, and a pay range reflecting

Qualifications

• MD or DO degree is required.
• Board Certification in an approved ABMS medical specialty.
• Current Louisiana and Oklahoma licenses or ability to obtain additional licenses.

Responsibilities

• Provide medical interpretation and determinations aligned with national guidelines, CMS, Humana policies and clinical standards.
• Collaborate with Humana colleagues and regional health services teams.
• Participate in utilization management, discharge planning, and post-acute services.
• Engage in grievance and appeals reviews when needed.
• Communicate decisions to internal associates and external physicians as required.

Skills

Verbal communication

Written communication

Analytic interpretation

Team collaboration

Education

MD or DO degree

Board Certification

Medical licenses (LA, OK)

Job description

Humana, Inc. is seeking a Medical Director to provide medical interpretation and determinations to ensure services align with national guidelines and CMS requirements. The role emphasizes collaboration with regional health services and Humana colleagues to support value-based care and population health initiatives.

Fully remote in the contiguous USA, with occasional travel for training or meetings. Typical hours are 40 per week, 8am-5pm Central time compatibility, and a pay range reflecting