Remote Medical Director - Utilization & Compliance

Humana, Inc.; Lansing (MI); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Health benefits

401(k) retirement savings

Paid time off

Disability insurance

Job summary

Humana, Inc. is seeking a Medical Director to interpret medical data and determine whether services meet national guidelines, CMS requirements, and Humana policies.

You will work with regional teams to support care management, quality, and population health initiatives. The role emphasizes collaboration, mentorship in training, and adherence to compliance timelines while operating in a fully remote capacity across the contiguous USA.

Qualifications

• MD or DO degree required and board certified.
• Strong analytical and interpretive capabilities with clinical data.
• Excellent written and verbal communication skills.

Responsibilities

• Provide medical interpretation and determinations against national guidelines and CMS requirements.
• Collaborate with Humana colleagues and regional leaders to execute care management objectives.
• Participate in eligibility, utilization management, and appeals processes as needed.

Skills

Analytical thinking

Communication skills

Team collaboration

Regulatory compliance understanding

Education

MD or DO degree

Tools

MCG guidelines

InterQual

Job description

Humana, Inc. is seeking a Medical Director to interpret medical data and determine whether services meet national guidelines, CMS requirements, and Humana policies.

You will work with regional teams to support care management, quality, and population health initiatives. The role emphasizes collaboration, mentorship in training, and adherence to compliance timelines while operating in a fully remote capacity across the contiguous USA.