Grievances and Appeals Corporate Medical Director

divh2Corporate Medical Director/h2pBecome a part of our caring community and help us put health first. The Corporate Medical Director 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 (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action./ppUse your skills to make an impact./ph3Required Qualifications/h3ulliMD or DO degree/lili2 or more years of project leadership experience/liliA current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment/liliBoard Certified in an approved ABMS Medical Specialty/liliExcellent communication skills/lili5 years of established clinical experience post residency/liliKnowledge of the managed care industry including Medicare, Medicaid and or Commercial products/liliPossess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab/liliMust be passionate about contributing to an organization focused on continuously improving consumer experiences/li/ulh3Preferred Qualifications/h3ulliMedical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc./liliInternal Medicine, Family Practice, Geriatrics, and Hospitalist clinical specialists/li/ulh3Additional Information/h3pThe Corporate Medical Director will conduct clinical case reviews of the care received by members in an assigned market, member population, or condition type. Though the Corporate Medical Director may serve as an expert in a particular condition or functional area, they do not typically spend time engaging in case reviews directly./ph3Work at Home Guidance/h3pTo ensure Home or Hybrid Home/Office associates ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:/pulliAt minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested/liliSatellite, cellular and microwave connection can be used only if approved by leadership/liliAssociates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense./liliHumana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job./liliWork from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information/li/ulpThis is a remote position. Travel: While this is a remote position, occasional travel to Humanas offices for training or meetings may be required./ph3Scheduled Weekly Hours/h3p40/ph3Pay Range/h3pThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $246,100 - $344,200 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance./ph3Description of Benefits/h3pHumana, Inc. and its affiliated subsidiaries (collectively, Humana) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities./ppApplication Deadline: 04-15-2026/ph3About Us/h3pHumana Inc. (NYSE: HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large./ph3Equal Opportunity Employer/h3pIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website./p/div