Medical Director - OneHome

Humana

5d • $223,800 - $313,100 • Remote

About The Position

The Medical Director reviews clinical cases for Medicare and Medicaid members and determines whether healthcare services—including Home Health, skilled nursing facility (SNF), durable medical equipment (DME), and dual Medicare/Medicaid requests—are medically necessary and consistent with national guidelines, CMS requirements, Humana policies, clinical standards, and applicable contracts. The role interprets and consistently applies clinical guidelines, CMS policies, and Medicare, Medicare Advantage, and Medicaid requirements while working within federal and state regulatory standards and defined timelines and departmental expectations. The position reports to the Lead Medical Director.

The Medical Director identifies operational improvement opportunities, contributes to a collaborative team culture, supports exceptional consumer experiences, and participates in educational activities, including required conferences and creating content in their subject-matter area. The role also supports Home Solutions and other activities assigned by OneHome leadership. Work is remote from home, with occasional travel to Humana offices for training or meetings. The schedule is 40 hours per week, Monday through Friday, 8:00 AM to 5:00 PM in the local/residing time zone after training, and includes call rotations with weekend and after-hours coverage. Onboarding lasts five weeks, with no time off during training; training is conducted in Eastern Standard Time. Home-based work requires a dedicated space that protects member PHI/HIPAA information and internet service with at least 25 Mbps download and 10 Mbps upload speed.

Requirements

• MD or DO degree.
• Current, active, ongoing board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialists (AOABPS); National Board of Physicians & Surgeons (NBPAS) certification is not accepted.
• Current, unrestricted medical license in at least one state and willingness to obtain additional licenses as required for states in the assigned region.
• No sanctions from federal or state governmental organizations.
• Five years of direct clinical patient-care experience after residency or fellowship.
• Ability to pass credentialing requirements.
• Intermediate to advanced skills using Microsoft Office and navigating the internet.
• Strong verbal and written communication skills, including the ability to analyze information and interpret data clearly and accurately.
• Adaptability and willingness to learn new technologies to improve workflow efficiency.
• Ability to work a 40-hour week, Monday through Friday, 8:00 AM to 5:00 PM, and participate in call rotations that include weekend and after-hours coverage.
• Ability to work in the local/residing time zone after training.
• Ability to complete five weeks of onboarding with no time off; training is in Eastern Standard Time.
• For remote work, internet service must provide at least 25 Mbps download and 10 Mbps upload speed, and work must be performed from a dedicated space that protects member PHI/HIPAA information.
• Ability to travel occasionally to Humana offices for training or meetings.

Nice To Haves

• Experience in an inpatient or outpatient environment and/or experience caring for a Medicare-type population, including disabled people or adults over age 65.
• Specialty background in Internal Medicine, Family Practice, Geriatrics, Physiatry, Emergency Medicine, Critical Care, Surgery, or a hospital-based clinical specialty.

Responsibilities

• Review clinical cases and determine the 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, and Medicaid requirements.
• Identify opportunities to improve medical management operations.
• Participate in call rotations, including weekend and after-hours coverage.
• Contribute to an engaged, collaborative team culture that supports organizational excellence.
• Deliver exceptional consumer experiences.
• Attend required conferences and create educational content reflecting individual subject-matter contributions.
• Support Home Solutions and other activities assigned by OneHome leadership.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company holidays, and personal holidays.
• Paid parental and caregiver leave.
• Short-term and long-term disability insurance.
• Life insurance.
• Bonus incentive plan based on company and/or individual performance.
• Other benefits and opportunities supporting personal wellness and healthcare decisions.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree