Remote Medical Director - Utilization & Case Management

Humana Inc; Des Moines (IA); 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 review services for Medicare/Medicaid populations in a remote role. You will interpret national guidelines, CMS requirements, and Humana policies while mentoring teammates and collaborating with care teams.

After mentored training, you will handle utilization management, disputes, and appeals across inpatient, outpatient, and post-acute settings, with occasional travel. Strong clinical background and board certification required.

Qualifications

• Analytical and interpretation skills with experience in quality/utilization/case management.
• Knowledge of Medicare/Medicaid and Medicare Advantage requirements.
• Experience in multidisciplinary teams focusing on care management and post-acute services.

Responsibilities

• Provide medical interpretation and determinations for services per guidelines and policy.
• Collaborate with teams and manage daily work after mentored training.
• Engage in utilization management, dispute and appeals reviews as needed.
• Communicate decisions to internal associates and support organizational priorities.

Skills

Analytical skills

Interpretation skills

Team collaboration

Communication with physicians

Education

MD or DO degree

Board Certification (ABMS/AOA)

Job description

Humana Inc. is seeking a Medical Director to review services for Medicare/Medicaid populations in a remote role. You will interpret national guidelines, CMS requirements, and Humana policies while mentoring teammates and collaborating with care teams.

After mentored training, you will handle utilization management, disputes, and appeals across inpatient, outpatient, and post-acute settings, with occasional travel. Strong clinical background and board certification required.