Remote Medical Director: Utilization & Care Quality Leader

Humana Inc; Lansing (MI); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work

Job summary

Humana Inc. seeks a Medical Director to authorize services and determine level of care in a remote, US-based role.

You will review complex clinical scenarios, interpret guidelines, and ensure compliance with CMS and Humana policies, primarily focused on post-acute rehabilitation and Medicare Advantage requirements. You will collaborate with clinical teams, participate in mentored training, and maintain rigorous documentation while meeting compliance timelines.

Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care post residency, preferably inpatient rehab.
• Board Certification in an ABMS/AOA specialty with ongoing certification.
• Current, unrestricted license in at least one jurisdiction.

Responsibilities

• Provide medical interpretation and determinations on acute inpatient rehabilitation authorization requests per guidelines and CMS requirements.
• Collaborate with teams and Humana colleagues to support the review process and outcomes.
• Participate in structured and mentored training; utilize team support during daily work.
• Maintain high standards in documentation and decision-making within a structured environment.
• Exercise independence to meet enterprise expectations and compliance timelines.
• Workfull-time, remote; forty hours per week; location within the United States.

Skills

MD/DO licensed clinician

Board Certified

Licensure in at least one state

Analytic and interpretation skills

Utilization management experience

Education

MD or DO degree

Job description

Humana Inc. seeks a Medical Director to authorize services and determine level of care in a remote, US-based role.

You will review complex clinical scenarios, interpret guidelines, and ensure compliance with CMS and Humana policies, primarily focused on post-acute rehabilitation and Medicare Advantage requirements. You will collaborate with clinical teams, participate in mentored training, and maintain rigorous documentation while meeting compliance timelines.