Humana Medical Director - Grievances and Appeals Lincoln, Nebraska
Become a part of our caring community and help us put health first
The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. This role works on problems of diverse scope and complexity ranging from moderate to substantial.
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. Represents Humana at Administrative Law Judge hearings. 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 is Monday-Friday with intermittent weekends OR a weekend shift with days off during the week.
Use your skills to make an impact
Required Qualifications
- MD or DO degree
- 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
- 5 years of established clinical experience
- Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
- Experience working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
- Clinical specialists in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and General Surgery
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.
Scheduled Weekly Hours: 40
Pay Range: $241,300 - $332,000 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.
Description of Benefits: Humana, Inc. offers competitive benefits that support whole-person well-being. Benefits include medical, dental and vision benefits, 401(k) retirement savings plan, paid time off, short-term and long-term disability, life insurance and more.
About us: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Our services aim to deliver care and service to millions, improving quality of life for various communities.
Equal Opportunity Employer: Humana does not discriminate against any employee or applicant for employment. We comply with all applicable federal civil rights laws and provide free language interpreter services.
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