Medical Director – Inpatient Review

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct expert clinical evaluations of inpatient medical records to determine medical necessity.

• Evaluate cases based on national guidelines, CMS regulations, Humana policies, and accepted clinical standards.

• Review complex hospital cases and make decisions regarding utilization management.

• Engage with external providers via phone to gather clinical information and discuss the results of reviews.

• Perform inpatient medical necessity assessments efficiently and in compliance with regulatory standards.

• Ensure productivity, precision, quality, and timely completion of assigned responsibilities.

• Clearly and professionally communicate review results in both verbal and written forms.

• Adapt to evolving workflows, tools, and utilization management protocols.

• Report directly to a Lead Medical Director.

• Participate in organizational committees or special project teams.

• Provide rotational weekend and holiday coverage, approximately five weekends per year.

⛳️ Requirements

• MD or DO degree.

• At least 5 years of post-residency clinical experience.

• Active, unrestricted medical license in at least one state, with a willingness to obtain additional licenses as necessary.

• Current and ongoing Board Certification in a medical specialty recognized by AOABPS or ABMS.

• Must fulfill all credentialing standards, with no state or federal sanctions.

• Strong analytical, communication, and documentation abilities.

• Capability to work efficiently within a structured environment and as part of a multidisciplinary team.

• Experience in inpatient settings, including hospitalist-level acuity, emergency department, intensive care unit, or hospital-based family/internal medicine.

• Previous experience in utilization management or inpatient review is preferred.

• Familiarity with MCG or InterQual guidelines is preferred.

• Experience working with Medicare populations and hospitals, integrated delivery networks, or medical management organizations is preferred.

• Proficiency in clinical technology platforms is preferred.

• Availability to work Monday through Friday, from 8 a.m. to 5 p.m. local time, with rotational weekend/holiday coverage.

• Capability to meet remote work requirements, including internet service with at least 25 Mbps download and 10 Mbps upload speeds.

• Ability to work from a dedicated space free from ongoing interruptions and to protect PHI/HIPAA information.

• Occasional travel to Humana offices for training or meetings may be required.

🏝️ Benefits

• Bonus incentive plan based on both company and/or individual performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Internet expense reimbursement for employees residing and working from home in California, Illinois, Montana, or South Dakota.

• Telephone equipment suitable for business needs.

• Remote work arrangement.

• Professional development initiatives.

• Opportunities for educational content and team teaching.