Corporate Medical Director – Grievances and Appeals
Humana
full-time
Posted on:
Location Type: Remote
Location: Remote • Kentucky • 🇺🇸 United States
Visit company websiteSalary
💰 $246,100 - $344,200 per year
Job Level
Lead
About the role
- Provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards
- Advises executives to develop functional strategies on matters of significance
- Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, working under minimal supervision
- Oversees the work of Medical Directors who conduct clinical case reviews of the care received by members in an assigned market, member population, or condition type.
- Serve as an expert in a particular condition or functional area
- Typically reports to a member of the corporate executive team
Requirements
- 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
Benefits
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
MD degreeDO degreeclinical experienceproject leadershipquality managementutilization managementdischarge planninghome healthrehab
Soft skills
communication skillsindependent judgmentdecision makingstrategic advising
Certifications
current and unrestricted medical licenseBoard Certified in ABMS Medical Specialty