Remote Medical Director - Utilization & Compliance Lead

Humana, Inc.; Topeka (KS); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work

Job summary

Humana, Inc. is seeking a Medical Director to provide medical interpretation and determinations on services in line with national guidelines, CMS requirements, and Humana policies. The role emphasizes collaboration with regional teams and adherence to compliance timelines.

The position supports remote work within the contiguous United States, with occasional travel for training or meetings. Candidates should have a medical degree and active board certification, plus extensive clinical

Qualifications

• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services.

Responsibilities

• Provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and contracts.
• Collaborates with team members, other departments, Humana colleagues and the Regional VP Health Services.
• Performs daily work with mentoring and adheres to compliance timelines.
• Participates in care management, utilization management, and potential grievance and appeals reviews.

Skills

Verbal communication

Written communication

Analytic skills

Interpretation skills

Utilization management

Education

MD or DO degree

Job description

Humana, Inc. is seeking a Medical Director to provide medical interpretation and determinations on services in line with national guidelines, CMS requirements, and Humana policies. The role emphasizes collaboration with regional teams and adherence to compliance timelines.

The position supports remote work within the contiguous United States, with occasional travel for training or meetings. Candidates should have a medical degree and active board certification, plus extensive clinical