Humana

Corporate Medical Director – Grievances and Appeals

Humana

full-time

Posted on:

Location Type: Remote

Location: Kentucky • United States

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Salary

💰 $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 & Tools
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