Humana
Corporate Medical Director - Medicare Grievances and Appeals (32-Hours)
Humana, Jefferson City, Missouri, United States, 65109
Overview
Become a part of our caring community and help us put health first The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The CMD works on problems of diverse scope and complexity ranging from moderate to substantial. The CMD provides medical interpretation and decisions regarding the appropriateness and medical necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD represents Humana at Administrative Law Judge hearings; exercises independent clinical judgment and decision making on complex issues; works under minimal supervision; and assists in supporting the medical director team and leaders in meeting enterprise-wide business needs.
After an initial training period, schedule is four 8-hour workdays per week, either Friday-Monday or Thursday-Sunday. Use your skills to make an impact Responsibilities
The Corporate Medical Director reviews health claims and preservice appeals, interprets medical information, and makes decisions regarding medical necessity in accordance with coverage policies and performance standards. The CMD represents Humana in Administrative Law Judge hearings and uses independent clinical judgment on complex issues. The role supports the medical director team and enterprise-wide business needs and operates with minimal supervision. Required Qualifications
MD or DO degree A current and unrestricted license in at least one state and willingness to obtain licenses as required for various states in region of assignment Board Certified in an approved ABMS Medical Specialty Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, or Physical Medicine and Rehab, Anesthesiology and General Surgery trained Excellent written and communication skills 5 years of established, post-residency clinical experience Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications
Medical utilization management experience Experience working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc. Work Arrangements
This is a remote position. Schedule : 32 hours per week, four 8-hour workdays per week, either Friday-Monday or Thursday-Sunday. Travel : Occasional travel to Humana's offices for training or meetings may be required. Compensation and Benefits
Pay Range: $246,100 - $344,200 per year. This range 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. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana offers competitive benefits that support whole-person well-being. Benefits include medical, dental and vision, 401(k) retirement savings, paid time off (including holidays and personal leave), paid parental and caregiver leave, disability, life insurance, and other opportunities. Application Deadline: 10-31-2025 About us
Humana 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 care and service when they need it. These efforts support better quality of life for people with Medicare, Medicaid, families, individuals, military personnel, and communities at large. Equal Opportunity Employer
Humana does not discriminate against employees or applicants based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Humana complies with Section 503 of the Rehabilitation Act and VEVRAA. This policy applies to all employment actions at all levels of employment. Humana also provides free language interpreter services. See our accessibility resources at Humanas legal site. #J-18808-Ljbffr
Become a part of our caring community and help us put health first The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The CMD works on problems of diverse scope and complexity ranging from moderate to substantial. The CMD provides medical interpretation and decisions regarding the appropriateness and medical necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD represents Humana at Administrative Law Judge hearings; exercises independent clinical judgment and decision making on complex issues; works under minimal supervision; and assists in supporting the medical director team and leaders in meeting enterprise-wide business needs.
After an initial training period, schedule is four 8-hour workdays per week, either Friday-Monday or Thursday-Sunday. Use your skills to make an impact Responsibilities
The Corporate Medical Director reviews health claims and preservice appeals, interprets medical information, and makes decisions regarding medical necessity in accordance with coverage policies and performance standards. The CMD represents Humana in Administrative Law Judge hearings and uses independent clinical judgment on complex issues. The role supports the medical director team and enterprise-wide business needs and operates with minimal supervision. Required Qualifications
MD or DO degree A current and unrestricted license in at least one state and willingness to obtain licenses as required for various states in region of assignment Board Certified in an approved ABMS Medical Specialty Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, or Physical Medicine and Rehab, Anesthesiology and General Surgery trained Excellent written and communication skills 5 years of established, post-residency clinical experience Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications
Medical utilization management experience Experience working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc. Work Arrangements
This is a remote position. Schedule : 32 hours per week, four 8-hour workdays per week, either Friday-Monday or Thursday-Sunday. Travel : Occasional travel to Humana's offices for training or meetings may be required. Compensation and Benefits
Pay Range: $246,100 - $344,200 per year. This range 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. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana offers competitive benefits that support whole-person well-being. Benefits include medical, dental and vision, 401(k) retirement savings, paid time off (including holidays and personal leave), paid parental and caregiver leave, disability, life insurance, and other opportunities. Application Deadline: 10-31-2025 About us
Humana 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 care and service when they need it. These efforts support better quality of life for people with Medicare, Medicaid, families, individuals, military personnel, and communities at large. Equal Opportunity Employer
Humana does not discriminate against employees or applicants based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Humana complies with Section 503 of the Rehabilitation Act and VEVRAA. This policy applies to all employment actions at all levels of employment. Humana also provides free language interpreter services. See our accessibility resources at Humanas legal site. #J-18808-Ljbffr