Physical Health Medical Director

Humana

. uses their medical background, experience, and judgement to determine whether requested services, level of care, or site of service should be authorized .

Posted 5/11/2026full-timeRemote • Ohio • 🇺🇸 United StatesLead💰 $223,800 - $313,100 per yearWebsite

About the role

Key responsibilities & impact

uses their medical background, experience, and judgement to determine whether requested services, level of care, or site of service should be authorized
learns Medicaid requirements and operationalizes this knowledge in daily work
conducts computer-based review of moderately complex to complex clinical scenarios
reviews all submitted clinical records, prioritizes daily work, communicates decisions to internal associates
participates in care management, with clinical scenarios arising from outpatient or inpatient environments
conducts discussions with external physicians by phone to gather additional clinical information or discuss determinations
may require conflict resolution skills
may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities
supports Humana values and our enterprise social needs team mission throughout all activities
flows to work as needed within cluster for vacations, weekends, and holiday coverage

Requirements

What you’ll need

Doctor of Medicine or Doctor of Osteopathy
Board-certified in ABMS or ABOA recognized specialty
A current and unrestricted license in at least one of the states that are part of the specific cluster, if required
At least five years of experience post-training providing clinical services
Experience in utilization management review and case management in a health plan setting
No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
Preferred: Experience working with Medicaid Enrollees, providers, and stakeholders in a clinical or administrative setting
Experience with accreditation process (NCQA)
Experience with CGX and MHK
Has licensure through the Interstate Medical Licensure Compact
Has a medical license in at least one of the states that are part of the specific cluster.

Benefits

Comp & perks

medical, dental and vision benefits
401(k) retirement savings plan
time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
short-term and long-term disability
life insurance
many other opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

utilization management reviewcase managementclinical servicesMedicaid requirementsaccreditation processCGXMHK

Soft Skills

conflict resolutioncommunication

Certifications

Doctor of MedicineDoctor of Osteopathyboard-certified in ABMSboard-certified in ABOAcurrent and unrestricted medical license