Medical Director - Medicare Grievances and Appeals Corporate

Humana; Brasil; Teletrabalho; BRL 300.000 - 400.000; Tempo integral

Resumo da oferta

A leading healthcare organization in Brazil is seeking a Corporate Medical Director to oversee health claims and provide medical decisions. The ideal candidate will have a medical background and demonstrate strong judgment skills in a complex healthcare environment. The position operates Monday through Friday with occasional weekends, requiring independent analysis and decision-making.

Qualificações

• Medical background required.
• Experience in reviewing health claims.
• Judgment and decision-making skills on complex issues.

Responsabilidades

• Review health claims and preservice appeals.
• Provide medical interpretation and decisions.
• Represent the company at Administrative Law Judge hearings.

Descrição da oferta de emprego

Overview

Become a part of our caring community and help us put health first. The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial. 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. Represents Humana at Administrative Law Judge hearings. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, using independent judgment requiring analysis of variable factors and determining the best course of action. Schedule is Monday-Friday with intermittent weekends.