Grievances and Appeals Corporate Medical Director

Grievances and Appeals Corporate Medical Director at Humana in Boise, Idaho, United States Job Description Become a part of our caring community and help us put health first 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. Advises executives to develop functional strategies (often segment specific) on matters of significance. 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. 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. Advises executives to develop functional strategies (often segment specific) on matters of significance. 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. Use your skills to make an impact Required Qualifications + MD or DO degree + 2 or more years of project leadership experience + 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 + Excellent communication skills + 5 years of established clinical experience post residency + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab + Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications + Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc. + Internal Medicine, Family Practice, Geriatrics, and Hospitalist clinical specialists Additional Information + The Corporate Medical Director will conduct clinical case reviews of the care received by members in an To view full details and how to apply, please login or create a Job Seeker account

Created: 2026-01-19