Corporate Medical Director – G&A

🔥 12 hours 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.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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 services rendered by other healthcare professionals • 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 involving variable factors, incomplete information, or competing clinical considerations • Act as a clinical resource for home health, rehabilitation, inpatient, outpatient, and transitional care services • Ensure appeal and grievance reviews reflect managed care operations and line-of-business requirements • 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 Internal Medicine, Family Practice, Geriatrics, and Hospital Medicine specialties • Support holiday or after-hours coverage as required to maintain regulatory and operational review timelines • Maintain awareness of emerging regulations, accreditation standards, and medical policy changes affecting grievance and appeal determinations • Complete on-demand HireVue assessment if selected to proceed

🎯 Requirements

• MD or DO degree • Current and unrestricted medical license in at least one jurisdiction • Able and willing to obtain a license without conditions, as required, for various states in the region of assignment • No current sanction from Federal or State Governmental organizations • Able 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 contributing to an organization focused on continuously improving consumer experiences • Medical utilization management experience in MA Grievances and Appeals 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 service with at least 25 Mbps download and 10 Mbps upload • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental, and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Personal wellness and smart healthcare decision support • Remote work arrangement • Occasional travel to Humana offices for training or meetings • Dedicated home workspace and internet requirements for working with member PHI/HIPAA information