Remote Medical Director: Utilization & Care Management

Humana; Harrisburg (Dauphin County); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana, Inc. is seeking a Medical Director to provide medical interpretation and determinations for services per national guidelines and CMS requirements. The role emphasizes collaboration with regional teams and mentorship, with independent, compliant daily work after training.

Fully remote in the contiguous USA, occasional travel to Humana offices may be required. Typical hours are 8am–5pm CST, with a focus on quality management and care coordination in post-acute settings.

Qualifications

• MD or DO degree required.
• 5+ years of direct clinical patient care post residency, inpatient experience preferred.
• Board Certification by an ABMS specialty.
• Current Louisiana and Oklahoma licenses (or ability to obtain).
• No current sanctions; able to pass credentialing requirements.
• Open to all US Territories; must work 8am–5pm Central Time.
• Excellent verbal and written communication skills.
• Experience in quality, utilization, case management, discharge planning or post-acute care.
• Utilization management of care for members in an assigned market; may include grievances.

Responsibilities

• Provide medical interpretation and determinations against national guidelines, CMS requirements, and Humana policies.
• Collaborate with team members and regional leaders; operate under mentored training before independent work.
• Ensure compliance with timelines and maintain consistent thinking and authorship.
• Support market-wide objectives (e.g., Bold Goal) and community relations as directed.

Skills

MD/DO degree

Board Certification

Licenses (LA & OK)

Clinical experience

Communication skills

Utilization management

Conflict resolution

Grievance & appeals

Teamwork & collaboration

Job description

Humana, Inc. is seeking a Medical Director to provide medical interpretation and determinations for services per national guidelines and CMS requirements. The role emphasizes collaboration with regional teams and mentorship, with independent, compliant daily work after training.

Fully remote in the contiguous USA, occasional travel to Humana offices may be required. Typical hours are 8am–5pm CST, with a focus on quality management and care coordination in post-acute settings.