Client: Humana Healthcare
Job Title: Medical Director Role
Pay Rate: $142.50/hr on W2 without any benefits or paid time off
Location: 100% REMOTE
Job ID: HUMJP00036030
Duration: 6+Months on W2 (Possibility of Contract to Hire based on performance)
Job Description:
Notes:
- Work Schedule: 40 hours with rotating weekend coverage; participation in weekend work on a rotational basis to ensure cases are decisioned in a timely manner
- Active Physician Credentials
- MD or DO degree
- Current, unrestricted medical license (at least one state)
- Active ABMS Board Certification
Job Overview:
We are seeking an experienced and board-certified Medical Director to join our clinical review team. In this role, you will be responsible for reviewing medical records, evaluating complex inpatient clinical scenarios, and making medical necessity determinations in alignment with national guidelines and payer policies.
This position requires strong clinical judgment, excellent communication skills, and the ability to independently manage case reviews while collaborating closely with other medical staff and external providers. Successful candidates will demonstrate professionalism, integrity, and a commitment to consistent and high-quality utilization management processes.
Key Responsibilities:
- Conduct timely and accurate medical necessity reviews for inpatient services.
- Evaluate complex clinical records and ensure alignment with national guidelines, CMS rules, client policies, and clinical standards.
- Communicate review determinations clearly and professionally both verbally and in writing.
- Collaborate with external healthcare providers to obtain additional clinical information and discuss case outcomes.
- Meet established productivity, quality, and compliance metrics.
- Maintain a strong understanding of client processes, workflows, and utilization management best practices.
- Contribute to a professional, team-based work environment.
- Adapt to evolving medical guidelines, tools, and technology workflows.
Required Qualifications
- MD or DO degree (mandatory).
- 5+ years of direct clinical practice experience post-residency or fellowship.
- Inpatient or hospital-based experience preferred.
- Experience with Medicare, aging populations, or complex adult care is a plus.
- Active, unrestricted medical license in at least one U.S. state (willingness to obtain additional licenses if required).
- Current ABMS Board Certification in an approved specialty.
- No sanctions from federal or state governmental organizations; must meet all credentialing requirements.
- Strong verbal and written communication skills.
- Demonstrated analytical and clinical interpretation abilities.
- Ability to work effectively in a structured, team-oriented environment.
Preferred Qualifications:
- Experience with Utilization Management, Medical Review organizations, or health plans (e.g., Medicare Advantage, Managed Medicaid, commercial insurance).
- Knowledge of CMS policies, InterQual, MCG, or similar clinical guidelines.
- Background in hospital-based specialties such as:
- Internal Medicine
- Family Practice
- Geriatrics
- Emergency Medicine
- Hospitalist
- Experience in integrated delivery systems or medical management organizations.
- Comfortable with technology, digital tools, and workflow optimization.
- Ability to adapt quickly within a dynamic, fast-paced environment.
- Interest in participating in training, educational sessions, or content development.
Why This Role?
- 100% remote flexibility
- Structured workflows and strong team support
- Opportunity to influence clinical quality and patient outcomes
- Professional and collaborative environment
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