Remote Medical Director, Utilization & Care Standards

Humana Inc; Dover (DE); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Medical Director to adjudicate inpatient and post-acute service requests, ensuring decisions align with national guidelines, CMS requirements, and Humana policies. The role involves reviewing complex cases, mentoring teams, and maintaining compliance.

The position supports Humana’s mission, involves remote work with periodic travel for training, and requires strong communication and analytical skills for quality and utilization management activities.

Qualifications

• MD or DO degree required.
• Current ABMS board certification in an approved medical specialty.
• Active medical license in at least one jurisdiction.

Responsibilities

• Provide medical interpretation and determinations aligned with guidelines, CMS requirements, and Humana policies.
• Mentor and collaborate with team members; perform reviews with minimal direction after training.
• Participate in quality management, utilization management, and discharge planning discussions as needed.

Skills

Medical knowledge

Clinical experience

Board certification

Medical license

Credentialing

Communication skills

Analytical skills

Education

MD/DO degree

Job description

Humana Inc. is seeking a Medical Director to adjudicate inpatient and post-acute service requests, ensuring decisions align with national guidelines, CMS requirements, and Humana policies. The role involves reviewing complex cases, mentoring teams, and maintaining compliance.

The position supports Humana’s mission, involves remote work with periodic travel for training, and requires strong communication and analytical skills for quality and utilization management activities.