Medical Director - Inpatient Review

Humana

2d•$223,800 - $313,100•Remote

About The Position

The Medical Director performs expert clinical review of inpatient medical records and assesses medical necessity using national guidelines, CMS regulations, Humana policies, and recognized clinical standards. The role analyzes complex hospital-based cases and makes clear, well-reasoned utilization management determinations. It includes contacting external providers by phone to obtain clinical information and discuss review outcomes, and collaborating in a structured, team-oriented environment. The position supports high-quality and consistent decision-making and strong physician partnerships. This remote position is open to candidates in the contiguous United States. Occasional travel to Humana offices for training or meetings may be required. Standard hours are Monday through Friday, 8 a.m. to 5 p.m. local time, with rotational weekend and holiday coverage of approximately five weekends per year. The role is scheduled for 40 hours per week and reports to a Lead Medical Director. Work-from-home employees need a dedicated space that protects member PHI/HIPAA information and internet service with at least 25 Mbps download and 10 Mbps upload speeds. The posted annual base-pay range is $223,800 to $313,100. The role is eligible for a bonus incentive plan based on company and/or individual performance. Humana offers medical, dental, and vision benefits; a 401(k) retirement savings plan; time off, including paid time off and company and personal holidays; paid parental and caregiver leave; short- and long-term disability; life insurance; and other benefits.

Requirements

MD or DO.
At least 5 years of post-residency clinical experience.
Active, unrestricted medical license in at least one state and willingness to obtain additional licenses as needed.
Current and ongoing board certification in an AOABPS- or ABMS-recognized medical specialty.
Meet all credentialing requirements, with no state or federal sanctions.
Strong analytical, communication, and documentation skills.
Ability to work effectively in a structured environment and as part of a multidisciplinary team.

Nice To Haves

Inpatient exposure at hospitalist-level acuity, in an emergency department or intensive care unit, or in hospital-based family or internal medicine.
Prior experience in utilization management or inpatient review, including Medicare Advantage, Managed Medicaid, or Commercial lines of business.
Familiarity with MCG or InterQual guidelines.
Experience caring for Medicare populations and working in hospitals, integrated delivery networks, or medical management organizations.
Adaptability to changes in workflows, regulatory requirements, or clinical systems.
Proficiency with clinical technology platforms and a commitment to process improvement and innovation.
Interest in contributing to educational content, team teaching, or professional development initiatives.
Dedication to consistent outcomes, exceptional consumer experiences, and an engaged team culture.

Responsibilities

Conduct inpatient medical necessity reviews promptly and in accordance with regulatory requirements.
Review inpatient medical records using national guidelines, CMS regulations, Humana policies, and recognized clinical standards.
Analyze complex hospital-based cases and make clear, well-reasoned utilization management determinations.
Contact external providers by phone to obtain clinical information and discuss review outcomes.
Maintain excellence in productivity, accuracy, quality, and timely completion of assigned tasks.
Communicate review outcomes clearly and professionally in verbal and written formats.
Adapt to changing workflows, tools, and utilization management procedures.
Collaborate with colleagues and physician partners to support consistent, high-quality decision-making.