Medical Director - Medicare Grievances and Appeals - Weekend - Remote

Overview

The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals, providing medical interpretation and decisions regarding the appropriateness and medical necessity of services.

In Short

• Full-time remote position with a schedule of four 10-hour workdays per week.
• Requires MD or DO degree and board certification in an ABMS Medical Specialty.
• 5 years of established, post-residency clinical experience is necessary.
• Knowledge of managed care industry including Medicare and Medicaid is essential.
• Excellent written and communication skills are required.
• Occasional travel to Humana's offices for training or meetings may be required.
• Competitive salary range of $246,100 - $344,200 per year.
• Eligible for a bonus incentive plan based on performance.
• Comprehensive benefits package including medical, dental, vision, and 401(k).
• Work from home with specific internet requirements.

Requirements

• MD or DO degree with a current and unrestricted license.
• Board Certified in an approved ABMS Medical Specialty.
• 5 years of clinical experience post-residency.
• Knowledge of Medicare, Medicaid, and managed care.
• Excellent communication skills.
• Preferred experience in medical utilization management.
• Experience working with health insurance organizations.
• Ability to work independently with minimal supervision.
• Passion for improving consumer experiences.
• Ability to protect member PHI / HIPAA information.

Benefits

• Competitive medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Generous paid time off and holidays.
• Short-term and long-term disability coverage.
• Life insurance and other opportunities for well-being.