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Humana Medical Director Jobs (NOW HIRING)

Humana, Inc.

Medical Director - OneHome

The Medical Director reviews and determines whether healthcare services provided by other healthcare professionals align with national guidelines, CMS requirements, Humana policies, clinical ...

Humana, Inc.

Medical Director - Claims

Become a part of our caring community The Medical Director uses their medical background ... These priorities may include an understanding of Humana processes, and a focus on collaborative ...

Humana, Inc.

Medical Director - Acute Rehab

The Medical Director's work includes computer-based review of moderately complex to complex ... Collaborate with team members, other departments, Humana colleagues, and clinical leadership to ...

Humana, Inc.

Medical Director - Inpatient Review

The Medical Director work assignments involve moderately complex to complex issues where the ... Advance Humana's mission by supporting high-quality, consistent decision-making and fostering ...

Humana, Inc.

BH/MH Medical Director - Medicare

The Behavioral Health Medical Directors support Humana values, and Humana's Bold Goal mission, throughout all activities. Use your skills to make an impact Use your skills to make an impact Required ...

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$232.4K

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How much do humana medical director jobs pay per year?

As of Jun 6, 2026, the average yearly pay for humana medical director in the United States is $232,369.00, according to ZipRecruiter salary data. Most workers in this role earn between $198,000.00 and $284,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Humana Medical Director, and why are they important?

To thrive as a Humana Medical Director, you need a medical degree (MD or DO), board certification, and extensive clinical experience, often in primary care or a relevant specialty. Familiarity with healthcare management systems, utilization review tools, and compliance regulations such as Medicare and Medicaid is typically required. Strong leadership, decision-making, and effective communication skills are crucial for collaborating with clinicians and administrative teams. These competencies are vital for ensuring high-quality, cost-effective care delivery and regulatory adherence within a complex healthcare organization.

What are some common challenges faced by a Humana Medical Director and how can they be addressed?

Humana Medical Directors often navigate complex decisions involving clinical policy, utilization management, and ensuring high-quality patient care while balancing cost efficiency. A common challenge is staying updated with constantly evolving healthcare regulations and evidence-based practices. Effective communication and collaboration with multidisciplinary teams, including clinicians, case managers, and administrators, are crucial to address these challenges. Proactive engagement in ongoing education and leveraging Humana’s resources can help Medical Directors remain effective and adaptable.

What is a Humana Medical Director?

A Humana Medical Director is a licensed physician who works for Humana, a major health insurance company. They oversee clinical programs, review medical necessity for healthcare services, and help develop policies to ensure that care provided to members is evidence-based and cost-effective. Medical Directors collaborate with healthcare providers, support utilization management, and play a key role in quality improvement initiatives. Their work ensures that Humana members receive appropriate, high-quality care while managing healthcare resources efficiently.

What is the difference between Humana Medical Director vs Humana Medical Reviewer?

AspectHumana Medical DirectorHumana Medical Reviewer
CredentialsMedical degree, medical license, often board-certifiedMedical degree, medical license, often board-certified
Work EnvironmentLeadership role overseeing clinical policies and provider networksReviewing claims and medical documentation for accuracy and coverage
Employer & IndustryHumana, healthcare insurance industry

The Humana Medical Director typically holds a leadership position, overseeing clinical operations and policy development, while the Humana Medical Reviewer focuses on evaluating medical claims and documentation. Both roles require medical credentials and work within the healthcare insurance industry, but they differ in responsibilities and level of seniority.

Infographic showing various Humana Medical Director job openings in the United States as of May 2026, with employment types broken down into 68% Part Time, and 32% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $232,369 per year, or $111.7 per hour.
Medical Director - OneHome

Medical Director - OneHome

Humana, Inc.

Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 22 days ago

Humana rating

8.0

Company rating: 8.0 out of 10

Based on 252 frontline employees who took The Breakroom Quiz

146th of 260 rated insurance

Job description

Become a part of our caring community
The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing Home Health, SNF, DME, dual Medicare/Medicaid requests. The Medical Director reviews and determines whether healthcare services provided by other healthcare professionals align with national guidelines, CMS requirements, Humana policies, clinical standards, and applicable contracts.
The Medical Director evaluates the medical necessity of healthcare services, ensuring decisions comply with regulatory and organizational standards. The role requires interpreting clinical guidelines, CMS policies, and Medicare requirements, and applying them consistently. All work at OneHome is conducted within a framework of regulatory compliance. This secures compliance with all requirements set by federal and state laws. Medical Directors review clinical cases for Medicare and Medicaid members, report to the Lead Medical Director, and work within defined timelines and departmental expectations.
Role Responsibilities:
  • Review clinical cases and determine medical necessity of services for Medicare and Medicaid members
  • Ensure compliance with review policies, procedures, and regulatory standards
  • Apply clinical guidelines, CMS policies, and Medicare/Medicare Advantage/Medicaid requirements
  • Identify opportunities for medical management operational improvements
  • Participate in call rotations, including weekend coverage and after-hours coverage
  • Contribute to an engaged, collaborative team culture that supports organizational excellence
  • Deliver exceptional consumer experiences
  • Support Home Solutions and other activities as assigned by the OneHome leadership

Use your skills to make an impact
Required Qualifications
  • MD or DO degree
  • Current, active and ongoing board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialties (AOABPS). National Board of Physicians & Surgeons (NBPAS) certification is not accepted
  • Current and unrestricted state license in at least one state and willing to obtain other medical licenses, as required, for various states in region of assignment
  • No sanctions from Federal or State Governmental organizations
  • 5 years of direct clinical patient care experience post residency or fellowship
  • The ability to pass credentialing requirements
  • Intermediate to advanced skills utilizing Microsoft Office and Internet navigation
  • Strong verbal and written communication skills, with the ability to analyze information and interpret data clearly and accurately
  • Adaptable and willing to learn new technologies to enhance workflow efficiency

Preferred Qualifications
  • Experience in an inpatient and/or outpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age)
  • Internal Medicine, Family Practice, Geriatrics, Physiatry, Emergency Medicine, Critical Care, Surgery or hospital based clinical specialists

Additional Information
  • Workstyle: remote work at home
  • Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM, call rotations, including weekend coverage and after-hours coverage
  • Training: 10 weeks of onboarding, no time off and training is in Eastern Standard Time (EST)

Work At Home Guidance
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 required.
  • Satellite, cellular and microwave connection can be used only if approved by leadership.
  • 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.

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About Humana

Sourced by ZipRecruiter

Humana Inc., headquartered in Louisville, KY., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Louisville, KY, US

Year founded

1961

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