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Medical Director, Medicare Grievances

Medical DirectorMedical DirectorOtherRemoteLeadTeam 10,001+Since 1961H1B SponsorCompany SiteLinkedIn

Location

California + 3 moreAll locations: California | Illinois | Montana | South Dakota

Posted

120 days ago

Salary

$246.1K - $344.2K / year

Seniority

Lead

Postgraduate Degree5 yrs expEnglish

Job Description

Medical Director, Medicare Grievances

Humana

• Corporate Medical Director relies on medical background and reviews health claims • Works on problems of diverse scope and complexity ranging from moderate to substantial • Provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards • Use independent decision-making on complex issues, requiring analysis of variable factors to determine the best course of action • Schedule is Monday-Friday with intermittent weekends • One weekend per month is generally required with compensation days given

Job Requirements

  • MD or DO degree
  • A current and unrestricted license in at least one jurisdiction and willing to obtain license for states in your 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
  • Analytical and interpretation skills, with prior experience leading teams focusing on quality management, utilization management, discharge planning and home health or rehab
  • 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, to include patient interactions
  • Internal Medicine, Family Practice, Geriatrics, Hospitalist clinical specialists

Benefits

  • medical, dental and vision benefits
  • 401(k) retirement savings plan
  • time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
  • short-term and long-term disability
  • life insurance and many other opportunities

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