Remote Medical Director: Utilization & Care Management

Humana, Inc.; Trenton (NJ); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement plan

Paid time off

Short-term and long-term disability

Life insurance

Job summary

Humana, Inc. is seeking a Medical Director to oversee medical determinations, ensure compliance with national guidelines, CMS requirements, and Humana policies.

This role involves collaborating with regional teams, providing expert input, and guiding complex case reviews across inpatient and post-acute settings. The position emphasizes Medicare Advantage and care management, with remote work in the contiguous USA and occasional travel.

Qualifications

• MD or DO required and board-certified.
• 5+ years clinical patient care experience.
• Active medical licenses in applicable states.
• Ability to obtain licenses without conditions.
• Knowledge of Medicare/Medicaid and care management.
• Willingness to work 8am-5pm CST.
• Strong communication and analytical skills.

Responsibilities

• Provide medical interpretations and determinations aligned with guidelines and policies.
• Collaborate with regional teams and VP Health Services.
• Mentored training with independent work and compliance timelines.
• Engage in utilization management of member care.
• Participate in grievance and appeals reviews.
• Support market-wide objectives and community relations.

Skills

Verbal communication

Written communication

Analytical skills

Credentialing

Utilization management

Education

MD or DO degree

Board Certification

Medical license (LA, OK)

Tools

Workday

HireVue

Job description

Humana, Inc. is seeking a Medical Director to oversee medical determinations, ensure compliance with national guidelines, CMS requirements, and Humana policies.

This role involves collaborating with regional teams, providing expert input, and guiding complex case reviews across inpatient and post-acute settings. The position emphasizes Medicare Advantage and care management, with remote work in the contiguous USA and occasional travel.