Medical Director

The Medical Director will be responsible for performing expert clinical reviews of inpatient medical records, assessing medical necessity based on national guidelines, CMS regulations, Humana policies, and recognised clinical standards.

Responsibilities:

• Conduct inpatient medical necessity reviews promptly and in accordance with regulatory requirements.
• Uphold excellence in productivity, accuracy, quality, and timely completion of assigned tasks.
• Communicate review outcomes clearly and professionally in both verbal and written formats.
• Demonstrate flexibility and adaptability to changing workflows, tools, and utilisation management procedures.

Requirements:

• MD or DO
• 5 or more years post-residency clinical experience
• Active, unrestricted medical licence in at least one state and willingness to obtain additional licences as needed
• Current and ongoing Board Certification in an AOABPS- or ABMS-recognised medical specialty
• Meets all credentialing requirements, with no state or federal sanctions
• Strong analytical, communication, and documentation skills
• Ability to work effectively within a structured environment and as part of a multidisciplinary team

Preferred Qualifications:

• Inpatient exposure (hospitalist-level acuity, ED, ICU, or hospital-based FP/IM)
• Prior experience in utilisation management or inpatient review (Medicare Advantage, Managed Medicaid, or Commercial lines of business)
• Familiarity with MCG or InterQual guidelines
• Experience providing care for Medicare populations and working in hospitals, integrated delivery networks (IDN), or medical management organisations

The Medical Director will work remotely in the contiguous US, with standard work hours from Monday to Friday, 8am-5pm local time, and rotational weekend/holiday coverage (approximately 5 weekends per year).

The compensation range for this role is $223,800 - $313,100 per year, and this job is eligible for a bonus incentive plan.