Corporate Medical Director - Medicare Grievances and Appeals (32-Hours)

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 remote role requires a strong clinical background and excellent communication skills to improve consumer experiences. You will be responsible for reviewing health claims, providing medical decisions, and representing the company at hearings. With a flexible schedule of four 8-hour workdays, you will enjoy a supportive work environment and comprehensive benefits. If you are passionate about healthcare and have a solid clinical foundation, this opportunity is perfect for you.

Benefits

Comprehensive health benefits

Wellness programs

Retirement support

Flexible work schedule

Qualifications

• MD or DO degree with a current, unrestricted license.
• 5+ years of post-residency clinical experience.

Responsibilities

• Review health claims and preservice appeals.
• Provide medical interpretation and decisions on services.

Skills

Clinical Judgment

Communication Skills

Knowledge of Managed Care

Experience in Internal Medicine

Experience in Family Practice

Experience in Geriatrics

Experience in Emergency Medicine

Education

MD or DO degree

Board Certification in ABMS-approved specialty

Job description

Corporate Medical Director - Medicare Grievances and Appeals (32-Hours)

Join to apply for the Corporate Medical Director - Medicare Grievances and Appeals (32-Hours) role at Humana.

This role involves reviewing health claims and preservice appeals, providing medical interpretation and decisions regarding the appropriateness and medical necessity of services, and representing Humana at Administrative Law Judge hearings. The position requires independent clinical judgment, minimal supervision, and supporting the medical director team to meet enterprise-wide needs.

The schedule is four 8-hour workdays per week, either Friday-Monday or Thursday-Sunday, after an initial training period.

Qualifications

• MD or DO degree with a current, unrestricted license in at least one state, willing to obtain licenses in other states as needed.
• Board Certified in an ABMS-approved specialty, with experience in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, Physical Medicine and Rehab, Anesthesiology, or General Surgery.
• At least 5 years of post-residency clinical experience.
• Knowledge of managed care, Medicare, Medicaid, or Commercial products.
• Excellent communication skills and a passion for improving consumer experiences.

Preferred Qualifications

• Experience in medical utilization management and working with healthcare organizations and providers.

Work Environment

This is a remote position requiring a dedicated workspace and reliable internet with specific speed requirements. Occasional travel to Humana offices may be required.

Compensation & Benefits

Salary ranges from $246,100 to $344,200 annually, with eligibility for bonuses. Humana offers comprehensive benefits supporting health, wellness, and retirement.

Application Deadline

07-31-2025