Medical Director - Medicare Grievances and Appeals Corporate

Medical Director - Medicare Grievances and Appeals Corporate at Humana in Boise, Idaho, United States Job Description Become a part of our caring community and help us put health first The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. 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. Represents Humana at Administrative Law Judge hearings. 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 Use your skills to make an impact Required Qualifications + MD or DO degree + 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 + Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications + Medical utilization management experience, + working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc. + Internal Medicine, Family Practice, Geriatrics, Hospitalist, Anesthesiology, Physical Medicine and Rehabilitation, Emergency Medicine, and General Surgery 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 To view full details and how to apply, please login or create a Job Seeker account