Corporate Medical Director of Grievances and Appeals

Join our dedicated team and make health a priority! The Corporate Medical Director is responsible for providing expert medical interpretations and decisions regarding the appropriateness of healthcare services offered by professionals. This role involves advising executives in developing targeted strategies that hold significant value. The position requires exercising independent judgment and decision-making skills on complex issues related to job functions, all while adhering to minimal supervision. You will analyze various factors to determine the optimal course of action. Schedule: 8am-5pm Thursday-Sunday, working 8-10 hours each day. Utilize your expertise to create a positive impact. Required Qualifications MD or DO degree. A minimum of 2 years in project leadership. A current, unrestricted medical license in at least one jurisdiction, with a willingness to obtain additional licenses as needed in the assigned states. Board Certification in an approved ABMS Medical Specialty. Exceptional communication skills. At least 5 years of clinical experience post-residency. Familiarity with the managed care landscape, including Medicare, Medicaid, and Commercial products. Strong analytical skills with a history of leading teams in areas such as quality management, utilization management, discharge planning, and/or home health or rehabilitation. Availability for occasional holidays is required. A passion for enhancing consumer experiences within a health-focused organization. Preferred Qualifications Experience in medical management with health insurance organizations or other providers. Specialties in Internal Medicine, Family Practice, Geriatrics, or Hospitalist practices. Additional Information The Corporate Medical Director will conduct clinical reviews related to the care provided to members in designated markets or populations. Although serving as an expert in specific conditions, the role typically does not involve direct case reviews. Remote Work Guidance To ensure effective performance from Home or Hybrid Home/Office associates, the following internet requirements apply: A minimum download speed of 25 Mbps and an upload speed of 10 Mbps is preferred; a wired cable or DSL connection is recommended. Satellite, cellular, and microwave connections are permissible only with leadership approval. Employees residing in California, Illinois, Montana, or South Dakota will receive a bi-weekly internet reimbursement. Humana will provide necessary telephone equipment for the role. It is essential to have a dedicated work space to ensure privacy and adherence to member PHI/HIPAA regulations. This position is fully remote. Travel: While primarily remote, occasional travel to Humana offices for training or meetings may be required. Weekly Scheduled Hours: 40 Salary Information: The projected annual compensation for this full-time position ranges from $246,100 to $344,200, reflecting a good faith estimate at the time of posting. Actual pay may vary based on location and individual qualifications including experience and education. This role is also eligible for a performance-based bonus incentive plan. About Our Benefits: Humana, Inc. and its subsidiaries offer competitive benefits aimed at promoting overall well-being. Our benefit packages support personal wellness and informed healthcare choices for you and your family, encompassing medical, dental, and vision coverage, a 401(k) retirement savings plan, various time-off options, and life insurance among others. Application Deadline: 07-30-2026 Who We Are: Humana Inc. (NYSE: HUM) is devoted to prioritizing health for all—our employees, customers, and communities. Through our insurance services and healthcare offerings, we facilitate access to the care needed to help millions achieve their best health, enhancing quality of life for individuals across various demographics. Equal Opportunity Employer: Humana upholds a strict non-discrimination policy by ensuring equal treatment for employment opportunities irrespective of race, religion, gender identity, age, or other protected statuses. We are also committed to taking affirmative action to employ individuals with disabilities or protected veterans.

Created: 2026-03-04