Medical Director

🕒 July 8

🇺🇸 United States – Remote

💵 $223.8k - $313.1k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

🦅 H1B Visa Sponsor

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👻 Ghost score 53%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Review clinical cases and determine medical necessity of services for Medicare and Medicaid members • Review Home Health, SNF, DME, and dual Medicare/Medicaid requests • Ensure healthcare services align with national guidelines, CMS requirements, Humana policies, clinical standards, and applicable contracts • Ensure compliance with review policies, procedures, regulatory standards, federal laws, and state laws • Apply clinical guidelines, CMS policies, and Medicare, Medicare Advantage, and Medicaid requirements • Identify opportunities for medical management operational improvements • Participate in call rotations, including weekend and after-hours coverage • Contribute to a collaborative team culture and deliver exceptional consumer experiences • Attend required conferences and create educational content for subject matter contributions • Support Home Solutions and other activities assigned by OneHome leadership • Report to the Lead Medical Director and work within defined timelines and departmental expectations

🎯 Requirements

• MD or DO degree • Current, active and ongoing board certification from ABMS or AOABPS; NBPAS certification is not accepted • Current and unrestricted state license in at least one state • Willingness to obtain other medical licenses as required for various states in the region of assignment • No sanctions from Federal or State Governmental organizations • 5 years of direct clinical patient care experience post residency or fellowship • Ability to pass credentialing requirements • Intermediate to advanced Microsoft Office and Internet navigation skills • Strong verbal and written communication skills • Ability to analyze information and interpret data clearly and accurately • Adaptability and willingness to learn new technologies • Ability to work a 40-hour work week, Monday through Friday, 8:00 AM to 5:00 PM • Ability to participate in weekend and after-hours call rotations • Ability to work in the local/residing time zone after training • Experience in an inpatient and/or outpatient environment or with a Medicare-type population (preferred) • Specialty background in Internal Medicine, Family Practice, Geriatrics, Physiatry, Emergency Medicine, Critical Care, Surgery, or hospital-based clinical specialties (preferred) • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Occasional travel to Humana offices for training or meetings • Remote work at home • Dedicated work space and internet requirements for working from home