Part-Time Medical Director: Medicare Appeals (Remote)

Humana, Inc.; Atlanta (GA); Remote; USD 124,000 - 207,000; Part time

Benefits offered by this job

Remote work

Bi-weekly internet expense

Flexible hours

Job summary

Humana, Inc. is seeking a Medical Director for a part-time, seasonal, remote role to review Medicare drug appeals (Part D and B).

You will collaborate with clinicians to ensure value-based care under Medicare and Humana policies, using CMS guidelines and recognized compendia. The position requires an MD/DO with an unrestricted license, board certification in relevant fields, and strong analytical and communication skills.

Qualifications

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

Responsibilities

• Review Medicare drug appeals (Part D and B).
• Collaborate with clinicians and staff to ensure value-based care.
• Analyze complex to moderately complex cases per Medicare rules and Humana policy.
• Operate within regulatory compliance and supported by CMS policies and clinical literature.
• Engage in team activities focused on quality and utilization management.

Skills

Medical license

Board certification

Analytical skills

Verbal & written communication

Team collaboration

Education

MD/DO degree

Tools

MCG guidelines

InterQual

NCCN

Medicare policies

Lexicomp

Job description

Humana, Inc. is seeking a Medical Director for a part-time, seasonal, remote role to review Medicare drug appeals (Part D and B).

You will collaborate with clinicians to ensure value-based care under Medicare and Humana policies, using CMS guidelines and recognized compendia. The position requires an MD/DO with an unrestricted license, board certification in relevant fields, and strong analytical and communication skills.