Corporate Medical Director – G&A

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide medical interpretation and clinical judgment regarding the necessity, appropriateness, and quality of services delivered by other healthcare professionals.

• Conduct or supervise clinical reviews of grievance and appeal cases for designated markets, member populations, or specific medical conditions.

• Ensure that determinations align with medical review policies, regulatory obligations, internal procedures, and performance standards.

• Act as a clinical subject matter expert for intricate grievance and appeal issues involving Medicare, Medicaid, and Commercial products.

• Make independent decisions on highly complex clinical matters that involve variable factors, incomplete information, or conflicting clinical considerations.

• Serve as a clinical resource for home health, rehabilitation, inpatient, outpatient, and transitional care services.

• Ensure that appeal and grievance reviews reflect managed care operations and business line requirements.

• Collaborate with cross-functional teams to enhance consistency, turnaround times, compliance, and member-centered decision-making.

• Contribute to initiatives aimed at improving member experience and minimizing preventable escalations or dissatisfaction.

• Provide expertise in Internal Medicine, Family Practice, Geriatrics, and Hospital Medicine specialties.

• Support holiday or after-hours coverage as necessary to maintain regulatory and operational review timelines.

• Stay informed about emerging regulations, accreditation standards, and medical policy changes that impact grievance and appeal determinations.

• Complete on-demand HireVue assessment if selected to advance in the hiring process.

⛳️ Requirements

• MD or DO degree.

• Current and unrestricted medical license in at least one jurisdiction.

• Willing and able to obtain a license without conditions as required in various states within the assigned region.

• No existing sanctions from Federal or State Governmental organizations.

• Capable of passing credentialing requirements.

• Board Certified in an approved ABMS Medical Specialty.

• Strong professional communication skills, both written and verbal.

• A minimum of 5 years of established clinical experience post-residency.

• Familiarity with the managed care industry, including Medicare, Medicaid, and/or Commercial products.

• A passion for contributing to an organization focused on continuously enhancing consumer experiences.

• Medical utilization management experience in MA Grievances and Appeals preferred.

• Experience collaborating with health insurance organizations, hospitals, healthcare providers, and patients preferred.

• Clinical specialization in Internal Medicine, Family Practice, Geriatrics, Hospitalist, Anesthesiology, Physical Medicine and Rehabilitation, Emergency Medicine, Neurology, or General Surgery preferred.

• Availability to work typical business hours Monday through Friday, 8 hours per day, 5 days per week, with holidays and weekends as required by business needs.

• Home internet service with a minimum of 25 Mbps download and 10 Mbps upload speeds.

• Capacity to work from a designated space without ongoing interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on both company and/or individual performance.

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Personal wellness and smart healthcare decision support.

• Remote work arrangement.

• Occasional travel to Humana offices for training or meetings.

• Dedicated home workspace and internet requirements for working with member PHI/HIPAA information.