Medicare Drug Appeals Director (Remote)

Humana Inc; Phoenix (AZ); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Remote work

Job summary

Humana Inc. in the United States is seeking a Medical Director to lead review of Medicare drug appeals (Part D & B) and support value-based care aligned with Humana policy. The role involves complex case analysis, cross-functional collaboration, and participation in hearings and CMS activities.

The position requires a physician with MD/DO, board certification, and unrestricted license, plus strong communication and analytical skills to drive high-quality outcomes for Humana members.

Qualifications

• MD or DO degree required.
• 5+ years of direct clinical patient care experience post doctorate.
• Board certification in preferred specialties (IM/FM/EM/PM&R).
• Current and unrestricted physician license in at least one jurisdiction.
• Ability to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Analytic and interpretation skills with quality/utilization management experience.

Responsibilities

• Review Medicare drug appeals (Part D & B) using Medicare rules and Humana policy.
• Collaborate with clinicians and staff to provide value-based care.
• Support audits, hearings, peer-to-peer discussions and cross-functional activities.

Skills

Excellent communication

Analytic skills

Team collaboration

Education

MD or DO degree

Board Certification (Internal Medicine / Family Medicine / Emergency Medicine / PM&R)

Job description

Humana Inc. in the United States is seeking a Medical Director to lead review of Medicare drug appeals (Part D & B) and support value-based care aligned with Humana policy. The role involves complex case analysis, cross-functional collaboration, and participation in hearings and CMS activities.

The position requires a physician with MD/DO, board certification, and unrestricted license, plus strong communication and analytical skills to drive high-quality outcomes for Humana members.