Corporate Medical Director

The Corporate Medical Director is a full-time remote role that relies on medical background and reviews of medical records for appeals decisions. The successful candidate will provide clinical interpretation and make determinations regarding the appropriateness of services delivered by other healthcare professionals.

Responsibilities:

• 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 all determinations are made in compliance 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, including cases with variable factors, incomplete information, or competing clinical considerations.
• Act as a clinical resource for issues involving home health, rehabilitation, inpatient, outpatient, and transitional care services.
• Ensure appeal and grievance reviews reflect knowledge of managed care operations, including Medicare, Medicaid, and Commercial line-of-business requirements.
• Partner with cross-functional teams to improve consistency, turnaround times, compliance, and member-centered decision-making.
• Contribute to initiatives focused on improving the member experience and reducing preventable escalations or dissatisfaction.
• Provide expertise across relevant clinical specialties such as Internal Medicine, Family Practice, Geriatrics, and Hospital Medicine.
• Support holidays and weekends as required based on business needs.

Requirements:

• MD or DO degree
• Current, unrestricted licensure in at least one jurisdiction
• No current sanction from Federal or State Governmental organizations
• Board Certified in an approved ABMS Medical Specialty
• 5 years of established clinical experience post-residency
• Knowledge of the managed care industry, including Medicare, Medicaid, and Commercial products

Preferred Qualifications:

• Medical utilization management experience in MA Grievances and Appeals
• Working with health insurance organizations, hospitals, and other healthcare providers
• Clinical specialists in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Anesthesiology, Physical Medicine and Rehabilitation, Emergency Medicine, Neurology, and General Surgery

Benefits:

• Competitive medical, dental, and vision benefits
• 401(k) retirement savings plan
• Time off, including paid time off, company and personal holidays, paid parental and caregiver leave
• Short-term and long-term disability
• Life insurance

Work Arrangement:

• Fully remote living in the contiguous USA
• Occasional travel to Humana's offices for training or meetings may be required

Schedule:

• Typical business hours are Monday-Friday, 8am-5pm
• Some flexibility might be possible, depending on business needs

Pay Range:

• $246,100 - $344,200 per year