Provide expert clinical review of inpatient medical records and determine medical necessity based on national guidelines, CMS requirements, Humana policies, and clinical standards
Job Summary
Provide expert clinical review of inpatient medical records and determine medical necessity based on national guidelines, CMS requirements, Humana policies, and clinical standards.
Join a collaborative team of physicians who bring clinical expertise to medical necessity review and help ensure members receive appropriate, guideline‑aligned inpatient care.
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
Matching Summary
Provide expert clinical review of inpatient medical records and determine medical necessity based on national guidelines, CMS requirements, Humana policies, and clinical standards.
Salary
Base: $223,800 - $313,100 per year; Bonus/Equity: eligible for bonus incentive plan; Benefits: medical, dental, vision, 401(k), time off, disability, life insurance