Medical Director - Inpatient Review

About the role

The Medical Director relies on medical background and reviews health claims. The role involves performing expert clinical reviews of inpatient medical records, analyzing complex cases, and communicating review outcomes. This position is well-suited for physicians with backgrounds in Hospital Medicine, Critical Care, Emergency Medicine, or Utilization Review.

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 utilization management procedures.

Requirements

• MD or DO degree with 5 or more years post-residency clinical experience.
• Active, unrestricted medical license in at least one state.
• Current and ongoing Board Certification in an AOABPS- or ABMS-recognized medical specialty.
• 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 utilization 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 organizations.
• Demonstrated adaptability to changes in workflow, 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 supporting consistent outcomes, exceptional consumer experiences, and a highly engaged team culture.

Additional Information

Reports directly to a Lead Medical Director. Standard work hours are Monday through Friday 8am-5pm local time, with rotational weekend/holiday coverage (approx. 5 weekends per year). May participate in organizational committees or special project teams. Work at Home: Requires a minimum download speed of 25 Mbps and an upload speed of 10 Mbps. Occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40. Pay Range: $223,800 - $313,100 per year. This job is eligible for a bonus incentive plan.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits include medical, dental, and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance, and many other opportunities.

About Us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.