Humana
Corporate Medical Director - Medicare Grievances and Appeals
Humana, Saint Paul, Minnesota, United States, 55130
Join our dedicated team and make a difference in healthcare!
The Corporate Medical Director plays a pivotal role in our organization, utilizing their medical expertise to review health claims and preservice appeals. This position involves addressing a variety of complex problems with a focus on the appropriateness of services provided by healthcare professionals in alignment with established policies and performance standards. The Director will represent Humana in Administrative Law Judge hearings, exercising independent judgment and making critical decisions on intricate issues with minimal supervision.
Work Schedule : Monday to Friday, with occasional weekend duties.
Key Qualifications
MD or DO degree Current and unrestricted medical license in at least one jurisdiction, with the willingness to obtain additional licenses as needed Board Certified in an approved ABMS Medical Specialty Exceptional communication skills A minimum of 5 years of clinical experience In-depth knowledge of the managed care industry, particularly Medicare, Medicaid, and/or Commercial products A genuine passion for enhancing consumer experiences Preferred Qualifications
Experience in medical utilization management Experience collaborating with health insurance organizations, hospitals, and other healthcare providers Specialty in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Anesthesiology, Physical Medicine and Rehabilitation, Emergency Medicine, or General Surgery Remote Work Requirements
To work effectively from home, associates must have a minimum internet connection of 25 Mbps download and 10 Mbps upload, with wired cable or DSL preferred. Satellite or cellular connections are only permissible with explicit approval from management. Associates residing in California, Illinois, Montana, or South Dakota will receive a bi-weekly stipend for their internet expenses. Humana provides necessary phone equipment for business needs. A quiet workspace is required to protect member PHI/HIPAA information. This is a remote position with potential travel for training or meetings at Humana offices. Weekly Work Hours
40 hours Compensation
The salary range for this position is between $246,100 - $344,200 per year, reflecting a good faith estimate of starting pay for full-time employment. Pay may vary based on location, skills, experience, and qualifications. This position is eligible for a performance-based bonus incentive plan. Benefits
Humana offers competitive benefits to support your overall well-being, including medical, dental, and vision coverage, a 401(k) retirement plan, generous paid time off, short and long-term disability, life insurance, and many more opportunities for personal and family health. Application Deadline:
11-30-2025 About Humana
Humana Inc. (NYSE: HUM) is dedicated to prioritizing health for our team members, customers, and communities. Through our insurance and healthcare services, we strive to improve the quality of life for individuals across Medicare, Medicaid, military personnel, and broader communities. Diversity Commitment
Humana is an equal opportunity employer, committed to fostering a diverse workforce and making employment decisions based solely on valid job-related criteria. We embrace an environment that celebrates differences and actively supports individuals with disabilities and protected veterans.
MD or DO degree Current and unrestricted medical license in at least one jurisdiction, with the willingness to obtain additional licenses as needed Board Certified in an approved ABMS Medical Specialty Exceptional communication skills A minimum of 5 years of clinical experience In-depth knowledge of the managed care industry, particularly Medicare, Medicaid, and/or Commercial products A genuine passion for enhancing consumer experiences Preferred Qualifications
Experience in medical utilization management Experience collaborating with health insurance organizations, hospitals, and other healthcare providers Specialty in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Anesthesiology, Physical Medicine and Rehabilitation, Emergency Medicine, or General Surgery Remote Work Requirements
To work effectively from home, associates must have a minimum internet connection of 25 Mbps download and 10 Mbps upload, with wired cable or DSL preferred. Satellite or cellular connections are only permissible with explicit approval from management. Associates residing in California, Illinois, Montana, or South Dakota will receive a bi-weekly stipend for their internet expenses. Humana provides necessary phone equipment for business needs. A quiet workspace is required to protect member PHI/HIPAA information. This is a remote position with potential travel for training or meetings at Humana offices. Weekly Work Hours
40 hours Compensation
The salary range for this position is between $246,100 - $344,200 per year, reflecting a good faith estimate of starting pay for full-time employment. Pay may vary based on location, skills, experience, and qualifications. This position is eligible for a performance-based bonus incentive plan. Benefits
Humana offers competitive benefits to support your overall well-being, including medical, dental, and vision coverage, a 401(k) retirement plan, generous paid time off, short and long-term disability, life insurance, and many more opportunities for personal and family health. Application Deadline:
11-30-2025 About Humana
Humana Inc. (NYSE: HUM) is dedicated to prioritizing health for our team members, customers, and communities. Through our insurance and healthcare services, we strive to improve the quality of life for individuals across Medicare, Medicaid, military personnel, and broader communities. Diversity Commitment
Humana is an equal opportunity employer, committed to fostering a diverse workforce and making employment decisions based solely on valid job-related criteria. We embrace an environment that celebrates differences and actively supports individuals with disabilities and protected veterans.