Corporate Medical Director - Medicare Grievances and Appeals (Part-Time)

Join our compassionate community and take a significant role in prioritizing health. As a Corporate Medical Director (CMD), you will leverage your medical expertise to review health claims and preservice appeals. This role involves tackling diverse and complex challenges, utilizing your skills to provide medical interpretations and make decisions about the appropriateness and medical necessity of services rendered by other healthcare professionals, all while ensuring compliance with coverage policies, procedures, and performance standards. In addition to reviewing health claims and preservice appeals, the CMD will represent Humana at Administrative Law Judge hearings and exercise independent clinical judgment on complex issues. You will be supported by the medical director team, contributing to the overall success of enterprise-wide business needs. The schedule for this role is organized as four 8-hour workdays per week, with options for Friday-Monday or Thursday-Sunday shifts following an initial training period. Key Responsibilities: Review health claims and preservice appeals. Provide medical interpretation and make determinations on medical necessity. Represent Humana at Administrative Law Judge hearings. Exercise independent clinical judgment on complex cases. Support the medical director team to fulfill enterprise-wide business requirements. Required Qualifications: MD or DO degree. A current and unrestricted medical license in at least one state, with a willingness to obtain additional licenses as needed for the region of assignment. Board Certification in an approved ABMS Medical Specialty. Training in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, Physical Medicine and Rehab, Anesthesiology, or General Surgery. Strong written and verbal communication skills. A minimum of 5 years of established post-residency clinical experience. Understanding of the managed care industry, including Medicare, Medicaid, and/or Commercial products. A passion for enhancing consumer experiences within a focused organization. Preferred Qualifications: Experience in medical utilization management. Background working with health insurance organizations, hospitals, and other healthcare providers. Work Environment and Scheduling: This is a remote position. The scheduled hours are 32 hours per week, structured as four 8-hour workdays (Friday-Monday or Thursday-Sunday). Occasional travel to Humana offices for training or meetings may be required. Work from Home Guidance: To facilitate effective remote work, your internet service should meet a minimum of 25 Mbps download and 10 Mbps upload speeds; acceptable connections include wired cable, DSL, or wireless connections. Satellite, cellular, and microwave connections need prior leadership approval. Associates in California, Illinois, Montana, or South Dakota may receive bi-weekly internet expense payments. Humana will provide necessary telephone equipment for remote work. Work must take place in a dedicated space that ensures the protection of member PHI/HIPAA information. Compensation and Benefits: The position entails a scheduled work week of 32 hours across four 8-hour days, with occasional travel to Humana offices for training or meetings. The expected pay range is $246,100 - $344,200 per year, which varies by geographic location and qualifications. This role is eligible for a bonus incentive plan based on performance, both at the company and individual levels. About Us: Humana Inc. is dedicated to placing health at the forefront for our teammates, customers, and the company. Through our insurance services and healthcare offerings, we are committed to helping millions achieve their best health by delivering the care and service they need when they need it. Our efforts contribute to an improved quality of life for individuals with Medicare, Medicaid, families, military personnel, and broader communities. Benefits: Humana provides competitive benefits that support the overall well-being of employees, including medical, dental, and vision coverage, a 401(k) retirement savings plan, paid time off, holidays, volunteer time off, parental leave, disability coverage, life insurance, and more. Application Deadline:

10-31-2025 Equal Opportunity Employer:

Humana maintains a policy of non-discrimination towards any employee or applicant based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We adhere to all federal civil rights laws and provide free language interpreter services. For further accessibility resources, please visit Humana's website.