Medicare Grievances and Appeals Corporate Medical Director
DescriptionThe Corporate Medical Director relies on medical background and reviews health claims. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial.
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. 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. Schedule is Monday-Friday with intermittent weekends.
- 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
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Medical management experience,
working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
Internal Medicine, Family Practice, Geriatrics, OBGYN, Hospitalist clinical specialists
Work at Home Guidance
To 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:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates 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.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
This is a remote position
Scheduled Weekly Hours40
Pay RangeThe 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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$241,300 - $332,000 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, 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.