Medical Director, Medicare Grievances

November 19

🏄 California – Remote

Although this job is listed in California, this company may be open to hiring remote in other states.

🌽 Illinois – Remote

Although this job is listed in Illinois, this company may be open to hiring remote in other states.

+2 more states

🏄 California – Remote 🌽 Illinois – Remote 🦬 Montana – Remote 🗿 South Dakota – Remote

💵 $246.1k - $344.2k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

🦅 H1B Visa Sponsor

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Humana

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Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

📋 Description

• The Corporate Medical Director relies on medical background and reviews health claims. • Works on problems of diverse scope and complexity ranging from moderate to substantial. • Provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. • 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.

🎯 Requirements

• 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 • Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab • Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

🏖️ Benefits

• 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.