Grievances and Appeals Corporate Medical Director
HumanaAbout the role
Become a part of our caring community and help us put health first
The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Use your skills to make an impact
Required Qualifications
MD or DO degree
2 or more years of project leadership experience
A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment
Board Certified in an approved ABMS Medical Specialty
Excellent communication skills
5 years of established clinical experience post residency
Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
Internal Medicine, Family Practice, Geriatrics, and Hospitalist clinical specialists
Additional Information
The Corporate Medical Director will conduct clinical case reviews of the care received by members in an assigned market, member population, or condition type. Though the Corporate Medical Director may serve as an expert in a particular condition or functional area, they do not typically spend time engaging in case reviews directly.
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates 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 associates 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
This is a remote position
#LI-Remote
Scheduled Weekly Hours
40Pay 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.
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 dApply for this role
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