Remote Medical Director: Utilization & Care Management

Humana, Inc.; Olympia (WA); 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, guided by national guidelines and CMS requirements.

The role emphasizes collaboration with regional teams and external physicians to support value-based care and population health initiatives. Fully remote within the contiguous United States, with occasional travel to Humana offices for training or meetings.

Qualifications

• Requires MD/DO with board certification and active medical licenses.
• Strong communication and analytical skills are essential.
• Ability to discuss and coordinate with external physicians and teams.
• Experience with quality management, utilization management, case management or post-acute services is valued.

Responsibilities

• Provide medical interpretation and determinations aligned with national guidelines and CMS requirements.
• Collaborate with Humana colleagues and regional leadership to meet market objectives.
• Mentor/train staff during onboarding and ensure compliance with timelines.
• Engage in grievance and appeals reviews when applicable.
• Communicate decisions clearly to internal associates and external physicians.

Skills

Communication skills

Analytical skills

Conflict resolution

Regulatory compliance

Education

MD/DO degree

Board Certification

Active medical licenses

Job description

Humana, Inc. is seeking a Medical Director to provide medical interpretation and determinations for services, guided by national guidelines and CMS requirements.

The role emphasizes collaboration with regional teams and external physicians to support value-based care and population health initiatives. Fully remote within the contiguous United States, with occasional travel to Humana offices for training or meetings.