Grievances and Appeals Corporate Medical Director

Company: Humana

Employment Type: Full-Time

Location: 100% Remote (Nationwide)

Compensation: $246,100 - $344,200 per year (plus bonus incentive plan)

Category: Physician / Healthcare

WHY THIS ROLE MADE THE CUT

• Fully remote (no hybrid or office requirements)

• Full-Time role

• Job is listed on company site with a direct link to apply

• Legitimate, established company

• Posted within the last 14 days

• Clear salary range is disclosed

ROLE SNAPSHOT

Humana is hiring a Corporate Medical Director for Grievances and Appeals to provide medical interpretation and clinical case reviews for members across an assigned market, population, or condition type. You'll evaluate the appropriateness of healthcare services provided by other professionals in compliance with review policies and performance standards, while advising executives on functional strategies. This role requires an MD or DO degree, board certification in an ABMS medical specialty, current unrestricted medical license (must obtain licenses for various states as needed), and 5+ years of established clinical experience post-residency. You'll need 2+ years of project leadership experience, knowledge of managed care (Medicare, Medicaid, Commercial products), and skills in quality management, utilization management, or discharge planning. The position exercises independent judgment on complex issues with minimal supervision and occasional travel to Humana offices for training or meetings. Bonus: Internal Medicine, Family Practice, Geriatrics, and Hospitalist specialists are preferred, and the role offers competitive benefits including medical, dental, vision, 401(k) with company match, and generous PTO.

KEY WORDS TO INCLUDE IN YOUR RESUME/COVER LETTER IF YOU APPLY:

• Board Certified physician

• Medical management

• Utilization management

• Quality management

• Medicare and Medicaid

• Clinical case reviews

• Project leadership

• Managed care industry

• Healthcare compliance

• Discharge planning

Keywords are suggested based on the language used in the employer's job description to help applicants align with automated screening systems.

Note: Job details on this site are accurate to the best of our knowledge at the time they are published. Please confirm all information directly with the employer before applying.