Remote Medical Director — Utilization & Care Management

Humana, Inc.; Madison (WI); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) retirement plan

Paid time off

Disability insurance

Life insurance

Job summary

Humana, Inc. is seeking a Medical Director to review health claims and authorize services using national guidelines and CMS policies. This role emphasizes data-driven decisions, regulatory compliance, and collaboration with regional teams.

The position is fully remote within the contiguous USA, with periodic travel for training and meetings. Typical hours align with 8am–5pm Central Time and require strong communication and clinical leadership.

Qualifications

• MD or DO degree and board certification as required.
• Strong communication skills for cross-functional teamwork and external discussions.
• Experience in utilization management and quality care initiatives.

Responsibilities

• Interpret medical information and determine service authorization per guidelines.
• Collaborate with Humana teams to support regional health services objectives.
• Engage in grievance and appeals processes when appropriate.
• Mentor/train staff and participate in care-management projects.

Skills

Verbal & written communication

Analytical skills

Utilization management

Medicare Advantage knowledge

Care management

Education

MD or DO degree

Job description

Humana, Inc. is seeking a Medical Director to review health claims and authorize services using national guidelines and CMS policies. This role emphasizes data-driven decisions, regulatory compliance, and collaboration with regional teams.

The position is fully remote within the contiguous USA, with periodic travel for training and meetings. Typical hours align with 8am–5pm Central Time and require strong communication and clinical leadership.