Medical Director, Medicare Grievances

Humana

15d • Remote

About The Position

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. 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. Use independent decision-making on complex issues, requiring analysis of variable factors to determine the best course of action. Schedule is Monday-Friday with intermittent weekends. One weekend per month is generally required with compensation days given. Use your skills to make an impact

Requirements

• MD or DO degree
• A current and unrestricted license in at least one jurisdiction and willing to obtain license for states in your region of assignment
• Board Certified in an approved ABMS or AOA Medical Specialty
• 5 years of established clinical experience - post residency
• Knowledge of the managed care industry including Medicare, Medicaid, and Commercial products
• Analytical and interpretation skills, with prior experience leading teams focusing on quality management, utilization management, discharge planning and home health or rehab
• Must be passionate about contributing to an organization focused on improving consumer experiences
• Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, to include patient interactions
• Internal Medicine, Family Practice, Geriatrics, Hospitalist clinical specialists
• 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 only be used if leadership approves it.
• 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 our requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• This is a remote position #LI-Remote

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: Ph.D. or professional degree