Remote Medical Director - Utilization & Care Management

Humana, Inc.; Salt Lake City (UT); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana, Inc. is seeking a Medical Director to perform medical review of services, determine authorization decisions, and support population health initiatives. The role emphasizes adherence to national guidelines, CMS requirements, and Humana policies.

The ideal candidate has MD/DO with 5+ years of clinical experience, board certification, and the ability to obtain state licenses. This is a remote position with occasional travel as needed and a strong emphasis on collaboration and compliance.

Qualifications

• MD or DO degree required.
• 5+ years of direct clinical patient care experience post residency or fellowship, inpatient or related to Medicaid-type population.
• Current ABMS board certification in a specified medical specialty.
• Current licenses (Louisiana/Oklahoma or ability to obtain) in good standing.

Responsibilities

• Interpret medical necessity and determine service authorization against national guidelines and CMS requirements.
• Collaborate with Humana colleagues and regional leadership to support health services.
• Participate in utilization management, quality and case management activities as needed.

Skills

Analytical interpretation

Verbal and written communication

Utilization management

Team collaboration

Education

MD or DO degree

Job description

Humana, Inc. is seeking a Medical Director to perform medical review of services, determine authorization decisions, and support population health initiatives. The role emphasizes adherence to national guidelines, CMS requirements, and Humana policies.

The ideal candidate has MD/DO with 5+ years of clinical experience, board certification, and the ability to obtain state licenses. This is a remote position with occasional travel as needed and a strong emphasis on collaboration and compliance.