Remote Medical Director - Utilization & Care Management

Humana, Inc.; Honolulu (HI); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana, Inc. seeks a Medical Director to review health claims and determine authorization for services, applying Medicare/Medicaid guidelines and Humana policies. This role emphasizes utilization management and collaboration with regional teams to meet Bold Goal objectives.

The position is fully remote in the contiguous USA, with typical hours 8:00–17:00 CST and limited travel for training. Strong clinical leadership and communication are essential.

Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care post residency or fellowship.
• Current ABMS Board Certification in medical specialty.
• Current Louisiana and Oklahoma licenses, and/or ability to obtain additional licenses.
• 8am–5pm CST working hours; US territory eligibility.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills in quality/utilization/care management.
• Experience with case management, discharge planning, or post-acute services.

Responsibilities

• Medical interpretation and determinations whether services meet national guidelines and Humana policies.
• Collaborate with Regional VP Health Services and teams; mentored training then independent work.
• Support market-wide objectives (e.g., Bold Goal) and community relations.

Skills

Excellent verbal and written沟通 skills

Analytic and interpretation skills

Education

MD or DO degree

Board Certification (ABMS medical specialty)

Job description

Humana, Inc. seeks a Medical Director to review health claims and determine authorization for services, applying Medicare/Medicaid guidelines and Humana policies. This role emphasizes utilization management and collaboration with regional teams to meet Bold Goal objectives.

The position is fully remote in the contiguous USA, with typical hours 8:00–17:00 CST and limited travel for training. Strong clinical leadership and communication are essential.