Medical Director

Humana

Medical Director overseeing compliance with Medicare guidelines and evaluating healthcare services. Leading a team in assessing medical necessity for Medicare and Medicaid members with a focus on regulatory adherence.

Posted 5/7/2026full-timeRemote • 🏈 Anywhere in North AmericaLead💰 $223,800 - $313,100 per yearWebsite

About the role

Key responsibilities & impact

Review clinical cases and determine medical necessity of services for Medicare and Medicaid members
Ensure compliance with review policies, procedures, and regulatory standards
Apply clinical guidelines, CMS policies, and Medicare/Medicare Advantage/Medicaid requirements
Identify opportunities for medical management operational improvements
Participate in call rotations, including weekend coverage and after-hours coverage
Contribute to an engaged, collaborative team culture that supports organizational excellence
Deliver exceptional consumer experiences
Support Home Solutions and other activities as assigned by the OneHome leadership

Requirements

What you’ll need

MD or DO degree
Current, active and ongoing board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialties (AOABPS).
National Board of Physicians & Surgeons (NBPAS) certification is not accepted
Current and unrestricted state license in at least one state and willing to obtain other medical licenses, as required, for various states in region of assignment
No sanctions from Federal or State Governmental organizations
5 years of direct clinical patient care experience post residency or fellowship
The ability to pass credentialing requirements
Intermediate to advanced skills utilizing Microsoft Office and Internet navigation
Strong verbal and written communication skills, with the ability to analyze information and interpret data clearly and accurately
Adaptable and willing to learn new technologies to enhance workflow efficiency

Benefits

Comp & perks

Medical, dental and vision benefits
401(k) retirement savings plan
Paid time off, company and personal holidays, volunteer time off
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance and many other opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical case reviewmedical necessity determinationclinical guidelines applicationCMS policiesMedicare requirementsMedicaid requirementsmedical management operational improvementsdirect clinical patient carecredentialing requirementsdata analysis

Soft Skills

collaborative team cultureconsumer experience deliverystrong verbal communicationstrong written communicationadaptabilitywillingness to learn

Certifications

MD degreeDO degreeboard certification from ABMSboard certification from AOABPSstate medical license