R-381302 - Medical Director - Medicare Grievances and Appeals

Job Summary

Become a part of our caring community and help us put health first. The Corporate Medical Director relies on a medical background and reviews health claims. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

• 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.
• Works under minimal supervision, using independent judgment requiring analysis of variable factors and determining the best course of action.

Schedule

• Monday-Friday with intermittent weekends.

Required Qualifications

• MD or DO degree
• A current and unrestricted license in at least one jurisdiction and willingness to obtain licenses as required for various states in the 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.
• Experience working with health insurance organizations, hospitals and other healthcare providers.
• Patient interaction experience.
• Clinical specialists in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, PM&R, Anesthesiology and General Surgery.

Work Location & Remote Work

• This is a remote position.
• 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 provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Compensation

• Scheduled Weekly Hours: 40
• Pay Range: $246,100 - $344,200 per year
• This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our 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
• Many other opportunities.