Find your next role
Discover roles across ambitious teams
19,734 jobs
- More jobs
Humana
Corporate MD Grievance & Appeals
Remote · United States · Full time · Senior level
$246k–$344k / year
About the role
Provide clinical interpretation and make determinations on medical appeals and grievances. Ensure compliance with policies and regulatory requirements for healthcare services.
What you’ll do
• Provide medical interpretation and clinical judgment. • Perform clinical reviews of grievance and appeal cases. • Ensure compliance with review policies and regulations. • Serve as clinical expert for Medicare, Medicaid, Commercial products. • Partner with teams to improve member experience.
What you’ll bring
• MD or DO degree. • Current unrestricted medical license in US jurisdiction. • No sanctions from government organizations. • Board Certified in ABMS Medical Specialty. • 5 years clinical experience post residency. • Knowledge of managed care industry.
Life at Humana
Offers competitive benefits including medical, dental, vision, 401(k), paid time off, parental leave, disability, and life insurance.
About Humana
Humana is a leading U.S. healthcare company providing insurance and healthcare services to millions, focusing on improving health outcomes and quality of life.