Corporate Medical Director – G&A

Humana

Corporate Medical Director guiding complex clinical grievance and appeal determinations for Humana, a U.S. healthcare and insurance company.

Posted 8/17/2026full-timeRemote • 🇺🇸 United StatesLead💰 $246,100 - $344,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical interpretation and clinical judgment, ensuring compliance with healthcare regulations and policies. Possesses strong clinical experience and knowledge of managed care, with a focus on improving member experiences and outcomes.

Highest-signal resume keywords

MD Or DO DegreeCurrent Medical LicenseBoard Certified In ABMS Medical Specialty5 Years Clinical Experience Post ResidencyMedical Utilization Management Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewGrievance And Appeal ManagementManaged Care KnowledgeClinical SpecializationMedical Policy Compliance

Soft Skills

Professional Communication SkillsDecision-MakingCollaboration

Certifications & Qualifications

Board Certification

Industry Keywords

MedicareMedicaidCommercial ProductsHealthcare ServicesClinical Judgment

About the role

Key responsibilities & impact

Provide medical interpretation and clinical judgment regarding the appropriateness, necessity, and quality of healthcare services
Perform or oversee clinical reviews of grievance and appeal cases for assigned markets, member populations, or condition-specific areas
Ensure determinations comply with medical review policies, regulatory requirements, internal procedures, and performance standards
Serve as a clinical subject matter expert for complex grievance and appeal matters involving Medicare, Medicaid, and Commercial products
Make independent decisions on highly complex clinical issues with variable factors, incomplete information, or competing clinical considerations
Act as a clinical resource for home health, rehabilitation, inpatient, outpatient, and transitional care services
Apply managed care knowledge to appeal and grievance reviews
Partner with cross-functional teams to improve consistency, turnaround times, compliance, and member-centered decision-making
Contribute to initiatives improving member experience and reducing preventable escalations or dissatisfaction
Provide expertise across relevant clinical specialties
Support holiday or after-hours coverage as required
Maintain awareness of emerging regulations, accreditation standards, and medical policy changes affecting determinations
Participate in on-demand candidate assessment and subsequent interview stages if selected

Requirements

What you’ll need

MD or DO degree
Current and unrestricted medical license in at least one jurisdiction
Ability and willingness to obtain an unrestricted license without conditions in additional states as required for the assigned region
No current sanction from Federal or State Governmental organizations
Ability to pass credentialing requirements
Board Certified in an approved ABMS Medical Specialty
Prompt professional communication skills, written and verbal
5 years of established clinical experience post residency
Knowledge of the managed care industry, including Medicare, Medicaid, and/or Commercial products
Passion for continuously improving consumer experiences
Medical utilization management experience in Medicare Advantage (preferred)
Experience working with health insurance organizations, hospitals, healthcare providers, and patients (preferred)
Clinical specialization in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Anesthesiology, Physical Medicine and Rehabilitation, Emergency Medicine, Neurology, or General Surgery (preferred)
Ability to work typical business hours Monday-Friday, 8 hours/day, 5 days/week, with holidays and weekends as required by business needs
Home internet with at least 25 Mbps download and 10 Mbps upload speed
Wireless, wired cable, or DSL internet connection suggested
Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical benefits
Dental benefits
Vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental leave
Paid caregiver leave
Short-term disability
Long-term disability
Life insurance
Occasional travel to Humana offices for training or meetings
Flexible work hours may be possible depending on business needs
Dedicated work-from-home arrangement