Grievances and Appeals Corporate Medical Director

Grievances and Appeals Corporate Medical Director page is loaded## Grievances and Appeals Corporate Medical Director locations:
Remote Nationwide time type:
Full time posted on:
Posted Todayjob requisition :
R-404387#
** 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. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment 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. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.
*
* Schedule:

8am-5pm Thurs-Sun 8-10 hours per day**#
** Use your skills to make an impact
**** Required Qualifications
*** 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, as required, for various states in region of assignment
* Board Certified in an approved ABMS Medical Specialty
* Excellent communication skills
* 5 years of established clinical experience post residency
* Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
* Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
* ** Occasional holidays required
*** Must be passionate about contributing to an organization focused on continuously improving consumer experiences
** Preferred Qualifications
*** Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
* Internal Medicine, Family Practice, Geriatrics, and Hospitalist clinical specialists
** Additional Information
*** The Corporate Medical Director will conduct clinical case reviews of the care received by members in an assigned market, member population, or condition type. Though the Corporate Medical Director may serve as an expert in a particular condition or functional area, they do not typically spend time engaging in case reviews directly.
** Work at Home Guidance
** To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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
* Satellite, cellular and microwave connection can be used only if approved by leadership
* 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 the business requirements for their position/job.
* Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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…