Medicare Drug Appeals Medical Director

Humana Inc; Annapolis (MD); Remote; USD 224.000 - 313.000; Vollzeit

Benefits dieser Stelle

Bonus incentive plan

Health benefits

Zusammenfassung

Humana Inc. is seeking a Medical Director to oversee Medicare drug appeals (Part D & B) with broad clinical expertise. You will review complex cases, collaborate with clinicians, and participate in hearings and CMS audits to support value-based care.

Strong analytical skills and board certification are essential, as is a current physician license in at least one state. The role supports remote work with occasional travel and offers a competitive base pay range aligned with geographic location

Qualifikationen

• MD or DO degree required.
• 5+ years of direct clinical patient care experience post doctorates.
• Board certification in internal medicine, family medicine, emergency medicine or PM&R preferred.
• Active license in at least one state and willingness to obtain additional licenses.
• Excellent verbal and written communication skills.
• Experience in quality/utilization management or related teams.

Aufgaben

• Review Medicare drug appeals (Part D & B) using Humana policies and Medicare rules.
• Collaborate with clinicians to deliver value-based care for Humana members.
• Engage in hearings, CMS audits and cross-functional team activities as needed.
• Support alignment with regulatory standards and documentation practices.

Kenntnisse

MD/DO degree

Clinical experience

Board certification

Licensed physician

Communication skills

Analytic skills

Ausbildung

MD or DO degree

Jobbeschreibung

Humana Inc. is seeking a Medical Director to oversee Medicare drug appeals (Part D & B) with broad clinical expertise. You will review complex cases, collaborate with clinicians, and participate in hearings and CMS audits to support value-based care.

Strong analytical skills and board certification are essential, as is a current physician license in at least one state. The role supports remote work with occasional travel and offers a competitive base pay range aligned with geographic location