Remote Medical Director: Utilization & Care Review

Humana Inc; Topeka (KS); 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

Disability insurance

Life insurance

Job summary

Humana Inc. is seeking a Medical Director to perform medical review and determinations for inpatient services in a remote capacity.

The role involves applying clinical judgement to ensure compliance with national guidelines, CMS requirements, and Humana policies, with mentorship during onboarding and collaboration across teams. Ideal candidates have an MD or DO, 5+ years of inpatient/post-acute care experience, ABMS board certification, and an unrestricted license.

Qualifications

• MD or DO degree is required.
• 5+ years direct clinical patient care post residency/fellowship.
• Board certification in an ABMS medical specialty.
• Active medical license in at least one jurisdiction.
• No current sanctions; able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Experience with quality management, utilization management, case management, discharge planning, or post-acute services.

Responsibilities

• Provide medical interpretation and determinations for services aligned with guidelines and CMS requirements.
• Collaborate with team members and Lead Medical Director; mentored training completed before independent work.
• Support market-wide objectives and community relations as directed.

Skills

MD/DO degree

Board Certification ABMS

Medical license

Communication skills

Analytic & interpretation

Inpatient care experience

Education

MD or DO

Job description

Humana Inc. is seeking a Medical Director to perform medical review and determinations for inpatient services in a remote capacity.

The role involves applying clinical judgement to ensure compliance with national guidelines, CMS requirements, and Humana policies, with mentorship during onboarding and collaboration across teams. Ideal candidates have an MD or DO, 5+ years of inpatient/post-acute care experience, ABMS board certification, and an unrestricted license.