Medical Director - Medicare Grievances and Appeals Corporate

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

Job summary

A leading healthcare company seeks a Medical Director for Medicare Grievances and Appeals, responsible for reviewing health claims and making critical decisions on healthcare services. The role requires an MD or DO degree, clinical experience, and a passion for improving consumer experiences. This remote position offers a competitive salary and comprehensive benefits.

Benefits

Comprehensive medical, dental, and vision benefits

401(k) plan

Paid time off

Disability and life insurance

Qualifications

• Current, unrestricted license in at least one jurisdiction.
• At least 5 years of clinical experience.
• Experience in medical utilization management preferred.

Responsibilities

• Review health claims and preservice appeals.
• Make decisions on appropriateness of healthcare services.
• Represent Humana at Administrative Law Judge hearings.

Skills

Communication

Problem Solving

Knowledge of managed care

Passion for improving consumer experiences

Education

MD or DO degree

Board Certified in an ABMS-approved specialty

Job description

Medical Director - Medicare Grievances and Appeals Corporate

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

Position Overview

The Corporate Medical Director relies on medical expertise to review health claims and preservice appeals. The role involves solving complex problems, providing medical interpretations, and making decisions on the appropriateness of healthcare services in compliance with policies and standards. The director may represent Humana at Administrative Law Judge hearings and exercises independent judgment on complex issues, working under minimal supervision.

Schedule

Monday-Friday with intermittent weekends or a weekend shift with days off during the week.

Qualifications

• MD or DO degree
• Current, unrestricted license in at least one jurisdiction; willingness to obtain additional licenses as required
• Board Certified in an ABMS-approved specialty
• Excellent communication skills
• At least 5 years of clinical experience
• Knowledge of managed care, Medicare, Medicaid, or Commercial products
• Passion for improving consumer experiences

Preferred Qualifications

• Experience in medical utilization management
• Experience working with health insurance organizations, hospitals, healthcare providers, and patients
• Specialists in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Anesthesiology, Physical Medicine and Rehabilitation, Emergency Medicine, or General Surgery

Work from Home Guidance

Requires reliable internet with minimum speeds of 25 Mbps download and 10 Mbps upload. Satellite, cellular, or microwave connections need approval. Employees in California, Illinois, Montana, or South Dakota may receive internet expense reimbursements. A dedicated workspace is required to protect patient information. This is a remote role with occasional travel for training or meetings.

Compensation and Benefits

Annual salary ranges from $246,100 to $344,200, with potential bonuses based on performance. Humana offers comprehensive benefits including medical, dental, vision, 401(k), paid time off, disability, life insurance, and more.

Application Deadline

07-31-2025

About Humana

Humana Inc. is dedicated to health and well-being, providing insurance and healthcare services to improve quality of life for diverse populations.

Equal Opportunity Employer

Humana values diversity and is committed to equal opportunity employment for all applicants and employees.