Remote Corporate Medical Director: Grievances & Appeals

Humana Inc; Santa Fe (NM); Remote; USD 246,000 - 344,000; Full time

Job summary

Humana Inc. invites applications for a Corporate Medical Director to provide clinical interpretation and decisions on the appropriateness of services.

You will oversee grievance and appeal reviews, ensure compliance with policies and regulatory requirements, and act as a clinical expert across Medicare, Medicaid, and Commercial products. The role emphasizes independent judgment on highly complex cases, collaboration with cross-functional teams, and support for home health and hospital services,

Qualifications

• MD or DO degree required and current license in at least one jurisdiction.
• Board certification in an ABMS medical specialty is required.
• Strong written and verbal communication; able to manage complex reviews.

Responsibilities

• Provide medical interpretation and clinical judgment on services rendered by other professionals.
• Oversee grievance and appeal case reviews for assigned markets and populations.
• Ensure determinations comply with policies, regulations, and performance standards.
• Serve as a clinical subject matter expert for Medicare, Medicaid, and Commercial products.

Skills

Clinical judgment

Independent decision-making

Communication skills

Regulatory/managed care knowledge

Interdisciplinary collaboration

Education

MD or DO degree

Board Certified in ABMS Medical Specialty

Job description

Humana Inc. invites applications for a Corporate Medical Director to provide clinical interpretation and decisions on the appropriateness of services.

You will oversee grievance and appeal reviews, ensure compliance with policies and regulatory requirements, and act as a clinical expert across Medicare, Medicaid, and Commercial products. The role emphasizes independent judgment on highly complex cases, collaboration with cross-functional teams, and support for home health and hospital services,