Remote Medical Director: Utilization & Care Reviews

Humana Inc; Carson City (NV); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

401(k) retirement plan

Bonus incentive plan

Job summary

Humana Inc. is seeking a Medical Director who will apply clinical judgment to authorize inpatient services in line with CMS and Humana policies. The role involves reviewing complex cases, coordinating with internal teams, and occasional peer discussions with external providers.

After mentored training, daily decisions are made with limited supervision. Travel to Humana offices may be required; the position enjoys a competitive benefits package and a bonus incentive plan.

Qualifications

• MD or DO degree required.
• 5+ years of direct clinical patient care post residency or fellowship.
• Current and ongoing ABMS board certification.
• Active and unrestricted medical license in at least one jurisdiction.
• No current sanction from federal or state authorities; must pass credentialing.

Responsibilities

• Provide medical interpretation and determinations aligning with national guidelines, CMS requirements, Humana policies, and clinical standards.
• Collaborate with team members and Lead Medical Director; operate with mentorship and then independently.
• Support market-wide objectives and community relations as directed.
• May participate in project teams or organizational committees; occasional external peer discussions.

Skills

Verbal & written comms

Analytic interpretation

Education

MD/DO degree

ABMS board certification

Active medical license

Job description

Humana Inc. is seeking a Medical Director who will apply clinical judgment to authorize inpatient services in line with CMS and Humana policies. The role involves reviewing complex cases, coordinating with internal teams, and occasional peer discussions with external providers.

After mentored training, daily decisions are made with limited supervision. Travel to Humana offices may be required; the position enjoys a competitive benefits package and a bonus incentive plan.