Part-Time Medical Director for Medicare Appeals (Remote)

Humana, Inc.; Frankfort (KY); Remote; USD 224,000 - 313,000; Part time

Job summary

Humana, Inc. seeks a part-time, seasonal Medical Director to review Medicare drug appeals (Part D and B).

This hourly, non-benefitted role involves flexible weekly hours and collaboration with clinicians to support value-based care in line with Medicare and Humana policies. Requirements include an MD or DO, an unrestricted license, and board certification in Internal Medicine, Family Medicine, Emergency Medicine, or PM&R, plus strong communication and analytical skills.

Qualifications

• MD or DO degree.
• Current and unrestricted license in at least one jurisdiction, willing to obtain additional license if required.
• Board Certification in Internal Medicine, Family Medicine, Emergency Medicine or Physical Medicine and Rehabilitation.
• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills, with prior experience in quality management or utilization management.

Responsibilities

• Review Medicare drug appeals (Part D and B) using Medicare rules and Humana policy.
• Collaborate with clinicians and staff to support value-based care.
• Operate within regulatory compliance and use CMS guidelines as appropriate.
• Perform computer-based review of complex drug coverage appeals.

Skills

Verbal communication

Written communication

Analytical skills

Team collaboration

Education

MD or DO degree

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

Job description

Humana, Inc. seeks a part-time, seasonal Medical Director to review Medicare drug appeals (Part D and B).

This hourly, non-benefitted role involves flexible weekly hours and collaboration with clinicians to support value-based care in line with Medicare and Humana policies. Requirements include an MD or DO, an unrestricted license, and board certification in Internal Medicine, Family Medicine, Emergency Medicine, or PM&R, plus strong communication and analytical skills.