Title: Medical Director - Inpatient Review Location: United States Remote, Nationwide Remote Job: Remote Job: Yes widget: Full time Category: Physician Humana Job ID: R-408818 Job Description: Become a part of our caring community The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Join a distinguished team of physicians dedicated to advancing the quality of inpatient care through clinical expertise and thoughtful medical necessity review. This position is well-suited for physicians who excel in case analysis, structured decision-making, and collaboration, offering an opportunity to impact patient outcomes without the physical demands or irregular hours of bedside care. Physicians with backgrounds in Hospital Medicine, Critical Care, Emergency Medicine, or those experienced in Utilization Review are encouraged to apply. Role Overview - Perform expert clinical review of inpatient medical records, assessing medical necessity based on national guidelines, CMS regulations, Humana policies, and recognized clinical standards. - Analyze complex hospital-based cases and deliver clear, well-reasoned utilization management determinations. - Communicate with external providers via phone to obtain clinical information and discuss review outcomes. - Collaborate within a structured, team-oriented environment that emphasizes integrity, professionalism, and collegiality. - Advance Humana's mission by supporting high-quality, consistent decision-making and fostering strong physician partnerships. 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. Use your skills to make an impact Required Qualifications - MD or DO - 5 or more years post-residency clinical experience - Active, unrestricted medical license in at least one state and willingness to obtain additional licenses as needed. - Current and ongoing Board Certification in an AOABPS- or ABMS-recognized 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 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 Internet Statement - To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. - Satellite, cellular and microwave connection can be used only if approved by leadership. - Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana''s offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay 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. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, 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. Learn more about what we offer at Humana.com and at CenterWell.com. 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.

Title: Behavioral Health Medical Director Location: Remote, Louisiana Remote Job: Remote Job: Yes Widget: Full time Category: Physician Humana Job ID: R-411376 Job Description: Description Become a part of our caring community The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Behavioral Health Medical Director may develop procedures, processes, productivity targets, and new delivery models. Maintains efficient operations while ensuring attainment of quality of care and financial goals. Provides information for pricing guidelines based on utilization patterns and client demographics. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. The Behavioral Health Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare, Medicare Advantage and/or Medicaid requirements, and will understand how to operationalize this knowledge in their daily work. The Behavioral Health Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management. The Behavioral Health Medical Directors support Humana values, and Humana’s Bold Goal mission, throughout all activities. Use your skills to make an impact Required Qualifications • MD or DO degree • 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare or Medicaid type population • Current and ongoing Board Certification an approved ABMS Medical or ABPN Specialty • A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. • No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. • Excellent verbal and written communication skills . • Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation. Preferred Qualifications • Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management. • Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. • Experience with national guidelines such as MCG® or InterQual • Psychiatry, Internal Medicine, Family Practice, Geriatrics, Hospitalist, or Emergency Medicine clinical specialists • Advanced degree such as an MBA, MHA, MPH• Exposure to Public Health, Population Health, analytics, and use of business metrics. • Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. • The curiosity to learn, the flexibility to adapt and the courage to innovate Additional Information Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. #physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay 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. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, 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. Learn more about what we offer at Humana.com and at CenterWell.com. ​ 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.

• Owning EMR review across our trial portfolio. • Working with engineering to refine our automated EMR screening. • Encoding eligibility criteria for new sponsor-direct trials. • Strategic medical leadership across the company. • Attending weekly customer meetings on our sponsor-direct trials. • Driving improvements across our portfolio. • Partnering across the team.

• Provides medical oversight of assigned clinical studies in the duty as a medical monitor • Often serves as primary medical contact for customers for assigned clinical studies • Responsible for protocol design and development, upon request • Provides medical and therapeutic input to Study Start Up, Feasibility, and Subject Identification efforts • Presents identified trends and issues to customers and project team members