Remote Medical Director — Utilization & Care Management

Humana Inc; Providence (RI); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement plan

Paid time off

Job summary

Humana Inc. is seeking a Medical Director to evaluate services for Medicare/Medicaid populations. You will review complex clinical scenarios, consult with physicians, and ensure compliance with national guidelines, CMS rules, and Humana policies.

Remote work with occasional travel; activities include mentored training and collaboration with care management. 40-hour work week; benefits include comprehensive health coverage, 401(k), paid time off, and performance incentives.

Qualifications

• MD or DO degree and board-certified medical practice.
• Minimum 5+ years of direct clinical patient care post residency or fellowship.
• Current and unrestricted license in at least one jurisdiction; willingness to obtain additional licenses.
• Experience with Medicare/Medicaid and Medicare Advantage is preferred.

Responsibilities

• Perform medical interpretation and determinations for services per national guidelines and CMS requirements.
• Collaborate with Humana colleagues and other teams; participate in mentored training, then daily work.
• Review clinical records and determine level of care, site of service, and utilization decisions.

Skills

Analytic skills

Interpreting guidelines

Communication with physicians

Collaboration

Utilization management experience

Care management familiarity

Education

MD or DO

Board Certification (ABMS/AOA)

Current unrestricted medical license

Job description

Humana Inc. is seeking a Medical Director to evaluate services for Medicare/Medicaid populations. You will review complex clinical scenarios, consult with physicians, and ensure compliance with national guidelines, CMS rules, and Humana policies.

Remote work with occasional travel; activities include mentored training and collaboration with care management. 40-hour work week; benefits include comprehensive health coverage, 401(k), paid time off, and performance incentives.