Remote Medical Director — Utilization & Inpatient Care

Humana Inc; Salem (OR); 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 apply clinical judgment in determining inpatient authorization decisions, leveraging national guidelines and CMS requirements.

The role supports a structured, compliant environment with collaboration across Humana teams and potential external peer discussions. The position requires an MD or DO, board certification, an unrestricted license, and a track record in inpatient/post-acute care quality and utilization management.

Qualifications

• MD or DO degree and active medical license.
• 5+ years of direct clinical patient care post residency or fellowship, preferably inpatient.
• Current and ongoing Board Certification an approved ABMS Medical Specialty.
• A current and unrestricted license in at least one jurisdiction and willingness to obtain additional license.
• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills, with experience in quality management, utilization management, case management, discharge planning or post-acute services.

Responsibilities

• Provide medical interpretation and determinations ensuring services align with national guidelines, CMS requirements, Humana policies, and clinical standards.
• Collaborate with team members and Lead Medical Director; perform duties after mentored training with consistent reasoning and authorship.
• Communicate decisions to internal associates and participate in project teams or committees.
• Support market-wide objectives and community relations as directed.
• Possible peer-to-peer discussions with external providers as needed.

Skills

Verbal and written communication

Analytic/interpretation skills

Education

MD or DO degree

Board-certified (ABMS)

Unrestricted medical license

Advanced degree (MBA/MHA/MPH)

Job description

Humana Inc. is seeking a Medical Director to apply clinical judgment in determining inpatient authorization decisions, leveraging national guidelines and CMS requirements.

The role supports a structured, compliant environment with collaboration across Humana teams and potential external peer discussions. The position requires an MD or DO, board certification, an unrestricted license, and a track record in inpatient/post-acute care quality and utilization management.