Humana Inc. is looking for a Grievances and Appeals Corporate Medical Director to provide medical interpretation and decisions on the appropriateness of care, advise on strategic initiatives, and oversee clinical case reviews. You will be a key part of a team committed to putting health first.
What You'll Do
- Provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals.
- Advise executives to develop functional strategies on matters of significance.
- Exercise independent judgment and decision making on complex issues regarding job duties and related tasks.
- Oversee the work of Medical Directors who conduct clinical case reviews.
What We're Looking For
- MD or DO degree with a current and unrestricted license in at least one jurisdiction.
- Board Certified in an approved ABMS Medical Specialty.
- 5 years of established clinical experience.
- 2 or more years of project leadership experience.
- Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products.
- Excellent communication skills.
- Analysis and interpretation skills with prior experience leading teams in areas like quality management or utilization management.
Nice to Have
- Medical management experience, working with health insurance organizations, hospitals and other healthcare providers.
- Clinical specialty in areas such as Internal Medicine, Family Practice, Geriatrics, OBGYN, or Hospitalist.
Team & Environment
This role typically reports to a member of the corporate executive team.
Benefits & Compensation
- Salary range: $246,100 - $344,200 per year.
- Medical, dental and vision benefits.
- 401(k) retirement savings plan.
- Comprehensive time off policies including paid time off, holidays, volunteer time, and parental leave.
- Short-term and long-term disability coverage.
- Life insurance.
Work Mode
This is a remote position.
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.
