Become a part of our caring community and help us put health first

The Corporate Medical Director relies on medical background and reviews health claims. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial.

Humana Clinical Contracting Team is looking for a medical director with utilization management process skills. This MD will provide legal representation for Humana at pre-litigation, case reviews and litigation. The MD would have an interest in policy, process and CMS regulation enforcement.

The MD will have had prior experience in public speaking, strong communication skills and high organization. This position will be required to provide depositions on Humana’s behalf and possibility of defending in the court room.

The MD will also support the Clinical Contracting Team to align on best practices, standardization in clinical contract clauses. Use of data analytics are key in determining trend outcomes with MD decisions making and understanding the audit process.

This position will work closely with the following Humana Enterprise Partners: Regulatory Compliance, legal, clinical risk, provider contracting, claims, post payment integrity, healthcare economics and clinical audit team.

Use your skills to make an impact

Required Qualifications:

• Board certified in an acknowledged America Board Medical discipline and in current up to date status
• Unrestricted US Medical license
• 5+ years of direct clinical patient care experience post residency or fellowship
• At least 2 years’ experience with Medicare Utilization Management
• Excellent communication skills
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications:

• Completion of Master of Business or Medical Management Masters
• Experience with public speaking

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information:

Position is 40 hrs/week. 10% travel. This is a corporate medical director position.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$241,300 - $332,000 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.

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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.