Corporate Medical Director - Medicare Grievances and Appeals

Humana; United States; Remote; USD 246,000 - 345,000; Full time

Job summary

An established industry player is seeking a Corporate Medical Director to lead Medicare Grievances and Appeals. This pivotal role requires a medical degree and extensive clinical experience. The ideal candidate will navigate complex healthcare challenges, ensuring compliance and quality in service delivery. With a focus on improving consumer experiences, this position offers the chance to make a significant impact in the healthcare sector. Join a caring community dedicated to health and wellness, where your expertise will contribute to meaningful improvements in patient care. Embrace this opportunity to lead and innovate in a dynamic environment.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid parental and caregiver leave

Short-term and long-term disability

Life insurance

Volunteer time off

Qualifications

• 2+ years of project leadership experience in healthcare.
• 5 years of established clinical experience in relevant fields.

Responsibilities

• Provide medical interpretation and decisions on health claims.
• Exercise independent judgment on complex healthcare issues.

Skills

Excellent communication skills

Analysis and interpretation skills

Project leadership experience

Knowledge of managed care industry

Clinical experience

Education

MD or DO degree

Board Certified in an approved ABMS Medical Specialty

Job description

Corporate Medical Director - Medicare Grievances and Appeals

Join to apply for the Corporate Medical Director - Medicare Grievances and Appeals role at Humana

Corporate Medical Director - Medicare Grievances and Appeals

2 weeks ago Be among the first 25 applicants

Join to apply for the Corporate Medical Director - Medicare Grievances and Appeals role at Humana

This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$246,100.00/yr - $344,200.00/yr

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. 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. 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. Schedule is Monday-Friday with intermittent weekends.

Required Qualifications

Use your skills to make an impact

• 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
• 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, Surgery, Hospitalist, Emergency Medicine, Anesthesiology
  
  

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

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.

$246,100 - $344,200 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.

Application Deadline: 06-30-2025

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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