Remote Medical Director: Utilization & Care Standards

Humana Inc; Santa Fe (NM); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work

Competitive benefits

Job summary

Humana Inc. seeks a Medical Director to apply medical expertise in determining inpatient authorization decisions, guided by national guidelines, CMS rules, and Humana policies.

The role involves reviewing moderately to complex clinical records, communicating decisions to colleagues, and collaborating with the Lead Medical Director.

Remote, full-time, requires MD/DO, ABMS board certification, an unrestricted license, and 5+ years of post-residency clinical care; travel may be required.

Qualifications

• MD or DO with ABMS board certification.
• 5+ years of direct clinical patient care post residency or fellowship, preferably inpatient.
• Current and unrestricted license in at least one jurisdiction.
• No current sanctions from federal or state authorities and able to credential.
• Excellent verbal and written communication skills.

Responsibilities

• Interpret medical information and determine service authorization aligned with guidelines and Humana policies.
• Review submitted clinical records and communicate decisions to internal associates.
• Collaborate with Lead Medical Director and cross-functional teams.
• Participate in quality management, utilization management, and discharge planning activities.

Skills

Verbal and written communication

Analytic and interpretation skills

Cross-functional collaboration

Education

MD or DO degree

ABMS board certification

Unrestricted medical license

Job description

Humana Inc. seeks a Medical Director to apply medical expertise in determining inpatient authorization decisions, guided by national guidelines, CMS rules, and Humana policies.

The role involves reviewing moderately to complex clinical records, communicating decisions to colleagues, and collaborating with the Lead Medical Director.

Remote, full-time, requires MD/DO, ABMS board certification, an unrestricted license, and 5+ years of post-residency clinical care; travel may be required.