Medical Director for Medicare Grievances Management

Join our dedicated team and focus on improving health outcomes The Medical Director is vital in overseeing health claims and applying medical expertise to navigate complex challenges in patient care. This role includes conducting medical evaluations and making pivotal decisions regarding the appropriateness of services provided by healthcare professionals, guaranteeing compliance with established policies and performance standards. The Medical Director will use independent judgment to tackle complex issues, performing responsibilities with minimal supervision while analyzing various factors to determine the best courses of action. This position requires a commitment from 8am-5pm Monday to Friday, with occasional weekend responsibilities based on business needs. Make a significant impact with your medical knowledge Required Qualifications MD or DO degree A current and unrestricted medical license in at least one state, with a willingness to secure additional state licenses as necessary Board Certification in an approved ABMS Medical Specialty Outstanding communication skills Minimum of 5 years of post-residency clinical experience Comprehension of the managed care landscape, particularly Medicare and Medicaid Strong analytical capabilities with experience in leading quality management and utilization management teams Availability to work on occasional holidays is required A genuine passion for enhancing consumer healthcare experiences Preferred Qualifications While this is mainly a non-leadership position, experience in medical management and collaboration with health insurance organizations, hospitals, and patient interactions is beneficial Specializations in Internal Medicine, Family Practice, Geriatrics, or as a Hospitalist are preferred Remote Work Requirements To facilitate effective remote or hybrid work, associates must ensure their internet meets the following criteria: A minimum download speed of 25 Mbps and upload speed of 10 Mbps; a wireless, wired cable, or DSL connection is recommended Satellite, cellular, and microwave connections are allowed only with leadership approval Additionally, associates working from specific states will receive a bi-weekly internet expense stipend Humana will provide necessary telephone equipment for the role Work from a dedicated, interruption-free space to ensure the security of member PHI / HIPAA information This position is primarily remote, though occasional travel to Humana's offices for training or meetings may be necessary. Scheduled Weekly Hours 40 Compensation Range The salary range represents a good faith estimate of starting base pay for full-time employment (40 hours a week). This range may vary based on geographic location, skills, experience, education, and certifications. $246,100 - $344,200 annually Additionally, this position qualifies for an incentive bonus based on both company and individual performance. Benefits Overview Humana, Inc. provides competitive benefits that promote overall well-being. Our benefits include medical, dental, and vision coverage, a 401(k) retirement plan, generous paid time off, volunteer leave, paid parental leave, and a variety of insurance options. Application Deadline: July 30, 2026 About Humana Humana Inc. is dedicated to prioritizing health for our teammates and the communities we serve. Through our insurance and healthcare services, we aim to improve access to quality care for Medicare, Medicaid participants, families, and individuals. Humana is an Equal Opportunity Employer Humana is committed to fostering an inclusive work environment, free from discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We take affirmative measures in compliance with relevant laws to promote employment opportunities for individuals with disabilities and protected veterans.

Created: 2026-03-04