Chief Medical Officer - Medicare Grievances and Appeals (32-Hours)

Join our compassionate team and prioritize health like never before!

As a Chief Medical Officer (CMO), you will leverage your medical expertise to review health claims and preservice appeals. In this role, you will tackle diverse problems ranging from moderate to complex, ensuring that medical interpretations and decisions regarding service appropriateness and necessity align with established coverage policies, procedures, and standards.

You will represent Humana in Administrative Law Judge hearings and demonstrate independent clinical judgment while addressing intricate issues related to your role. This position offers minimal supervision, allowing you to contribute to the medical director team and fulfill enterprise-wide business goals. After initial training, enjoy a flexible schedule of four 8-hour workdays weekly, either Friday-Monday or Thursday-Sunday.

Make a meaningful impact with your skills!

Required Qualifications

MD or DO degree

A current and unrestricted state license; must be willing to obtain others as necessary

Board Certified in an approved ABMS Medical Specialty

Specialties : Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, Physical Medicine and Rehab, Anesthesiology, or General Surgery

Strong written and verbal communication skills

5+ years of post-residency clinical experience

Knowledge of the managed care industry, including Medicare and Medicaid

Commitment to enhancing consumer experiences

Preferred Qualifications

Experience in medical utilization management

Background in collaborating with health insurance organizations, hospitals, and healthcare providers

Work from Home Guidelines

To facilitate effective remote work, associates are expected to meet the following internet criteria :

A minimum of 25 Mbps download speed and 10 Mbps upload speed is recommended; wired cable or DSL is preferred

Satellite, cellular, and microwave connections require prior approval

Associates in California, Illinois, Montana, or South Dakota will receive a bi-weekly internet expense reimbursement

Humana will supply the necessary telephone equipment

Work from a dedicated, interruption-free space to safeguard member PHI / HIPAA information

This is a remote position.

Scheduled Weekly Hours

32 hours : Four 8-hour workdays either Friday-Monday or Thursday-Sunday.

Pay Range

The compensation range represents a good faith estimate of starting pay for full-time (40 hours / week) roles at the time of posting. Actual pay may vary based on geographic location and individual qualifications, including skills, education, and experience.

$246,100 - $344,200 per year

This position is eligible for a bonus incentive plan, tied to company and / or individual performance.

Benefits Overview

Humana, Inc. offers competitive benefits supporting holistic wellbeing. Our benefits are designed to promote your personal wellness and smart healthcare choices for you and your family, recognizing that life extends beyond work. Benefits include medical, dental, and vision plans, a 401(k) retirement savings plan, paid time off, short- and long-term disability, life insurance, and more.

Application Deadline : 10-31-2025

About Humana

Humana Inc. is dedicated to prioritizing health for our teammates, customers, and communities. Through our integrated insurance services and healthcare offerings, we strive to empower millions to achieve their optimal health, enhancing quality of life for those we serve.

Equal Opportunity Employment

Humana maintains a policy of non-discrimination against employees or applicants based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We actively take measures to employ individuals from these communities and base employment decisions solely on valid job requirements.

Humana complies with all federal civil rights laws and does not discriminate based on race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. We provide free language interpreter services.