Join Our Caring Community and Prioritize Health The Medical Director plays a vital role in ensuring high-quality health services by relying on extensive knowledge of CMS Medicare Guidance. In this role, you will review home health, SNF, DME, dual Medicare/Medicaid, and Waiver requests to determine compliance with national guidelines, CMS requirements, Humana policies, and clinical standards. This position involves making critical medical decisions regarding the appropriateness of services provided by healthcare professionals. Your work will be grounded in regulatory compliance, utilizing various resources such as national clinical guidelines, CMS policies, and internal teaching sessions. You will also develop a solid understanding of Medicare and Medicare Advantage requirements and apply this knowledge consistently in your daily tasks within a structured environment. Utilize Your Expertise to Make an Impact Required Qualifications MD or DO degree Current and ongoing board certification in an approved ABMS Medical Specialty A current and unrestricted license in at least one jurisdiction; willingness to obtain additional licenses as required 5+ years of direct clinical patient care experience post residency or fellowship No sanctions from Federal or State Governmental organizations Ability to pass credentialing requirements Excellent verbal and written communication skills, along with strong analytic and interpretative abilities Participation in educational activities, including attendance at required conferences and creating content for presentations Preferred Qualifications Experience in an inpatient environment or working with Medicare populations (disabled or over 65 years old) Background in Internal Medicine, Family Practice, Geriatrics, Physiatry, Emergency Medicine, Critical Care, or related clinical specialties Able to thrive in a dynamic, fast-paced environment Commitment to a culture of innovation and teamwork Passion for enhancing organizational consistency in outcomes and consumer experiences Knowledge of national guidelines such as NCD/LCD, MCG, or InterQual The Medical Director will be responsible for conducting clinical case reviews for Medicare members and will report directly to the Lead Medical Director. Additional Duties: Identify operational improvements within medical management Participate in call rotation, which may include weekend coverage Develop collaborative relationships with team members and key partners within the Medicare Line of Business Support Home Solutions as needed Other tasks as assigned by the managing Medical Director While this is a remote position, occasional travel to Humana's offices for training or meetings may be necessary. Scheduled Weekly Hours 40 Compensation Range The compensation range below reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. Compensation may vary based on geographic location and individual qualifications. $223,800 - $313,100 per year This position is also eligible for a bonus incentive plan based on company and/or individual performance. Description of Benefits Humana, Inc. offers competitive benefits designed to support whole-person well-being. Benefits include medical, dental and vision coverage, a 401(k) retirement savings plan, generous paid time off (including personal holidays and parental leave), short and long-term disability, life insurance, and more. Application Deadline: 08-31-2025 About Us Humana Inc. is dedicated to prioritizing health for our team members, customers, and communities. Through our insurance services and healthcare services, we work tirelessly to help millions achieve their best health by providing the care and support they need. Equal Opportunity Employer Humana maintains a policy of equal employment opportunity without discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We comply with all federal civil rights laws and ensure accessibility for all individuals.