Corporate Medical Director G&A

Overview

Become a part of our caring community and help us put health first

The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. You will advise executives to develop functional strategies (often segment specific) on matters of significance. Exercise independent on complex issues regarding job responsibilities and related tasks, and works, uses requiring analysis of variable factors and determining the best course of action.

The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. You will advise executives to develop functional strategies (often segment specific) on matters of significance. Exercise independence on complex issues regarding job responsibilities and related tasks, requiring analysis of variable factors and determining the best course of action.

• The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards.

• You will advise executives to develop functional strategies (often segment specific) on matters of significance.

• Exercise independence on complex issues regarding job responsibilities and related tasks, requiring analysis of variable factors and determining the best course of action.

• MD or DO degree

• 2 or more years of project leadership experience

• A current and unrestricted license in at least one jurisdiction and willing to obtain license, for multiple states in the region of assignment

• Board Certified in an approved ABMS or AOA Medical Specialty

• 5 years of established clinical experience post residency

• Knowledge of the managed care industry including Medicare, Medicaid and Commercial products

• Have interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and home health or rehab

• Occasional holidays required

• Must be passionate about contributing to an organization focused on improving consumer experiences

• Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction.

• Internal Medicine, Family Practice, Geriatrics, and Hospitalist clinical specialists

• The Corporate Medical Director will conduct clinical case reviews of the care received by members in an assigned market, member population, or condition type. You may serve as an expert in a condition or functional area; they do not typically spend time engaging in case reviews directly.

• To ensure Home or Hybrid Home/Office associates have the self-provided internet service you must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Leadership approves satellite, cellular and microwave connection for use only if they give approval.

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet our requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

#Grievances And Appeals

This is a remote position

#LI-Remote Nationwide

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay…