Medicare Grievances and Appeals Corporate Medical Director
Remote US
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 OR a weekend shift with days off during the week
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, 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 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
This is a remote position
Scheduled Weekly Hours
40Pay Range
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Dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Illinois Montana Remote US South Dakota Work from a dedicated space Work from a dedicated space lacking ongoing interruptions Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Work from Home in the state of California, Illinois, Montana, or South Dakota
Benefits/PerksBonus incentive plan Competitive benefits Dental Health insurance Life Insurance Medical Medical, dental, and vision benefits Paid parental and caregiver leave Paid Time Off Parental and Caregiver Leave Personal holidays Remote position Time off Vision Vision Benefits Volunteer time Volunteer time off
Tasks- Compliance
- Decision making
- Medical interpretation
- Training
Analysis BI Business Clinical Clinical Experience Communication Compliance Healthcare Healthcare Professionals Health Insurance HIPAA Leadership Managed Care Medicaid Medical background Medical interpretation Medicare Recruitment Training Utilization management Wellness
Experience5 years
EducationAssociates Business Communication DO Education Healthcare Management M.D.
CertificationsABMS Medical Specialty Board Certified in an approved ABMS Medical Specialty
TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9