Remote Medical Director - Utilization & Rehab

Humana Inc; Jackson (MS); Remote; USD 224.000 - 313.000; Vollzeit

Benefits dieser Stelle

Health benefits

401(k)

Paid time off

Remote work flexibility

Zusammenfassung

Humana Inc. seeks a Medical Director to authorize services and determine level of care for DSNP programs. The role emphasizes compliance with CMS and Humana policies.

You will review complex clinical records, discuss determinations with external physicians, and work remotely from any U.S. location. Requirements include MD/DO, 5+ years inpatient/rehabilitation care, and current medical licensure with ABMS/AOA board certification.

Qualifikationen

• MD or DO degree with board certification in an ABMS/AOA specialty.
• Current, unrestricted medical license in at least one jurisdiction.
• Experience in utilization management and quality improvement.
• Strong analytic, interpretive, and documentation skills.

Aufgaben

• Provide medical interpretation and determinations on acute inpatient rehabilitation requests.
• Collaborate with teams to support the review process and outcomes.
• Participate in structured training programs and ongoing team support.
• Maintain high standards in documentation and decision making.
• Work independently to meet compliance timelines and enterprise expectations.
• This is a full-time remote position with 40 hours per week; can be performed from anywhere in the United States.

Kenntnisse

Analytic skills

Interpretation skills

Utilization management

Collaboration

Communication

Ausbildung

MD or DO

Board Certified ABMS/AOA

Current unrestricted medical license

Jobbeschreibung

Humana Inc. seeks a Medical Director to authorize services and determine level of care for DSNP programs. The role emphasizes compliance with CMS and Humana policies.

You will review complex clinical records, discuss determinations with external physicians, and work remotely from any U.S. location. Requirements include MD/DO, 5+ years inpatient/rehabilitation care, and current medical licensure with ABMS/AOA board certification.