Corporate Medical Director - Grievances and Appeals
At Humana, we strive to provide high-quality healthcare services to our members and ensure their satisfaction with our services. As the Corporate Medical Director for Grievances and Appeals, you will play a crucial role in overseeing and managing the resolution of member complaints and appeals. We are seeking a highly skilled and compassionate medical professional who is dedicated to upholding our commitment to excellence in member care. If you have a passion for advocating for patients and ensuring their needs are met, we encourage you to apply for this rewarding position. Join our team and make a positive impact on the lives of our members.
- Oversee the resolution of member complaints and appeals, ensuring timely and accurate handling of grievances.
- Develop and implement processes and protocols for addressing member concerns and ensuring compliance with regulatory requirements.
- Collaborate with cross-functional teams to identify and address systemic issues that may contribute to member complaints.
- Serve as the primary point of contact for regulatory agencies and external auditors regarding grievances and appeals.
- Provide guidance and support to internal teams on grievance and appeal procedures, including training and education.
- Monitor and analyze data related to member complaints and appeals, identifying trends and recommending improvements to enhance member satisfaction.
- Ensure compliance with company policies and procedures, as well as federal and state regulations related to grievances and appeals.
- Foster a culture of continuous improvement and innovation within the grievances and appeals department.
- Serve as a liaison between members and healthcare providers, advocating for timely and appropriate resolution of grievances and appeals.
- Stay informed about industry trends and best practices related to member satisfaction and grievances and appeals processes.
Medical Degree: A Corporate Medical Director At Humana Must Possess A Medical Degree From An Accredited Institution. This Ensures That They Have A Strong Understanding Of Medical Terminology, Procedures, And Treatments.
Board Certification: The Ideal Candidate For This Position Should Be Board-Certified In A Relevant Medical Specialty Such As Internal Medicine, Family Medicine, Or Pediatrics. This Ensures That They Have A Deep Understanding Of Medical Procedures And Can Provide Expert Guidance To The Team.
Experience In Grievances And Appeals: The Ideal Candidate Should Have At Least 5 Years Of Experience In A Similar Role, With A Specific Focus On Grievances And Appeals. This Ensures That They Have A Solid Understanding Of The Processes And Regulations Involved In Handling Such Cases.
Leadership Skills: A Corporate Medical Director At Humana Must Have Strong Leadership Skills To Effectively Manage A Team And Drive Results. They Should Have Experience In Setting Goals, Developing Strategies, And Motivating A Team To Achieve Them.
Communication Skills: As A Key Liaison Between The Medical Team And The Corporate Leadership, The Corporate Medical Director Should Have Excellent Communication Skills. They Should Be Able To Clearly Articulate Complex Medical Information To Non-Medical Professionals And Advocate For The Best Interests Of The Organization.
Communication
Time Management
Leadership
Conflict Resolution
Analytical Thinking
Regulatory compliance
Problem-Solving
team
Decision-Making
Medical Expertise
Appeals Process
Grievance Management
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
creativity
Teamwork
Active Listening
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Corporate Medical Director - Grievances and Appeals is $200,000 - $250,000 per year. However, this can vary depending on the specific company, location, and level of experience. Some Corporate Medical Directors in this role may earn up to $300,000 or more per year. Additionally, bonuses and other benefits may also be included in the compensation package.
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Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.
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