Corporate Medical Director - Medicare Grievances and Appeals (32-Hours) (Baton Rouge)

Corporate Medical Director

Become a part of our caring community and help us put health first. The Corporate Medical Director relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the appropriateness and medical necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD represents Humana at Administrative Law Judge hearings; exercises independent clinical judgment and decision making on complex issues regarding job duties and related tasks; works under minimal supervision; and assists in supporting the medical director team and leaders in meeting enterprise-wide business needs. After an initial training period, schedule is four 8-hour workdays per week, either Friday-Monday or Thursday-Sunday. Use your skills to make an impact.

Required Qualifications :

• MD or DO degree
• A current and unrestricted license in at least one state and willing to obtain license, as required, for various states in region of assignment
• Board Certified in an approved ABMS Medical Specialty
• Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, or Physical Medicine and Rehab, Anesthesiology and General Surgery trained
• Excellent written and communication skills
• 5 years of established, post-residency clinical experience
• Knowledge of the managed care industry including Medicare, Medicaid and / or Commercial products
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications :

Work at Home Guidance :

This is a remote position. Scheduled weekly hours : 32 hours : four 8-hour workdays per week, either Friday-Monday or Thursday-Sunday schedule. Travel : While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Pay Range : $246,100 - $344,200 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and / or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, Humana) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline : 10-31-2025

About Us : Humana Inc. (NYSE : HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer : It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services.