Remote Medical Director: Utilization & Care Oversight

Humana Inc; Austin (TX); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Job summary

Humana Inc. is seeking a Medical Director to review complex inpatient and post-acute cases, ensuring alignment with national guidelines and CMS requirements. The role supports Humana values, collaborates across teams, and may include peer discussions and coding practices review.

Responsibilities include clinical decision-making, mentoring, and participating in discharge planning, quality and utilization reviews. Travel to Humana offices may be required occasionally.

Qualifications

• MD or DO degree required.
• Current and ongoing Board Certification in an approved ABMS Medical Specialty.
• Current and unrestricted medical license in at least one jurisdiction; willingness to obtain others if required.
• Excellent verbal and written communication skills; strong analytic and interpretation abilities.

Responsibilities

• Provide medical interpretation and determinations on whether services align with national guidelines, CMS requirements, Humana policies, and clinical standards.
• Collaborate with team members and Lead Medical Director; work with minimal supervision after mentored training.
• Participate in quality management, utilization management, case management, discharge planning, and post-acute services reviews as applicable.

Skills

Verbal and written communication

Analytical interpretation

Team collaboration

Education

MD or DO

Job description

Humana Inc. is seeking a Medical Director to review complex inpatient and post-acute cases, ensuring alignment with national guidelines and CMS requirements. The role supports Humana values, collaborates across teams, and may include peer discussions and coding practices review.

Responsibilities include clinical decision-making, mentoring, and participating in discharge planning, quality and utilization reviews. Travel to Humana offices may be required occasionally.