Corporate Medical Director – G&A

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $246.1k - $344.2k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • 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.

📋 Description

• Provide medical interpretation and clinical judgment regarding the appropriateness, necessity, and quality of healthcare services • Perform or oversee clinical reviews of grievance and appeal cases for assigned markets, member populations, or condition-specific areas • Ensure determinations comply with medical review policies, regulatory requirements, internal procedures, and performance standards • Serve as a clinical subject matter expert for complex grievance and appeal matters involving Medicare, Medicaid, and Commercial products • Make independent decisions on highly complex clinical issues with variable factors, incomplete information, or competing clinical considerations • Act as a clinical resource for home health, rehabilitation, inpatient, outpatient, and transitional care services • Apply managed care knowledge to appeal and grievance reviews • Partner with cross-functional teams to improve consistency, turnaround times, compliance, and member-centered decision-making • Contribute to initiatives improving member experience and reducing preventable escalations or dissatisfaction • Provide expertise across relevant clinical specialties • Support holiday or after-hours coverage as required • Maintain awareness of emerging regulations, accreditation standards, and medical policy changes affecting determinations • Participate in on-demand candidate assessment and subsequent interview stages if selected

🎯 Requirements

• MD or DO degree • Current and unrestricted medical license in at least one jurisdiction • Ability and willingness to obtain an unrestricted license without conditions in additional states as required for the assigned region • No current sanction from Federal or State Governmental organizations • Ability to pass credentialing requirements • Board Certified in an approved ABMS Medical Specialty • Prompt professional communication skills, written and verbal • 5 years of established clinical experience post residency • Knowledge of the managed care industry, including Medicare, Medicaid, and/or Commercial products • Passion for continuously improving consumer experiences • Medical utilization management experience in Medicare Advantage (preferred) • Experience working with health insurance organizations, hospitals, healthcare providers, and patients (preferred) • Clinical specialization in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Anesthesiology, Physical Medicine and Rehabilitation, Emergency Medicine, Neurology, or General Surgery (preferred) • Ability to work typical business hours Monday-Friday, 8 hours/day, 5 days/week, with holidays and weekends as required by business needs • Home internet with at least 25 Mbps download and 10 Mbps upload speed • Wireless, wired cable, or DSL internet connection suggested • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Occasional travel to Humana offices for training or meetings • Flexible work hours may be possible depending on business needs • Dedicated work-from-home arrangement