Part-Time Medical Director - Remote & Flexible Hours

Humana, Inc.; Austin (TX); Remoto; USD 224.000 - 313.000; Tempo parcial

Resumo da vaga

Humana, Inc. is seeking a Medical Director (part-time, seasonal) to review Medicare drug appeals and support value-based care across teams. The role emphasizes regulatory compliance and uses CMS guidelines, NCCN, and Humana policies.

The ideal candidate holds MD/DO, a current license, and board certification in relevant specialties; strong communication and analytic skills are essential. Remote work with occasional travel to Humana offices may be required.

Qualificações

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

Responsabilidades

• Review Medicare drug appeals (Part D and Part B) and determine medical necessity.
• Collaborate with clinicians and staff to deliver value-based care.
• Operate within CMS policies, Humana policies, and clinical literature as appropriate.
• Conduct computer-based review of complex appeals for coverage.
• Support value-based care initiatives while maintaining regulatory compliance.

Conhecimentos

Medical license

Communication

Analytic skills

Team collaboration

Formação

MD or DO degree

Board Certification

Descrição da vaga

Humana, Inc. is seeking a Medical Director (part-time, seasonal) to review Medicare drug appeals and support value-based care across teams. The role emphasizes regulatory compliance and uses CMS guidelines, NCCN, and Humana policies.

The ideal candidate holds MD/DO, a current license, and board certification in relevant specialties; strong communication and analytic skills are essential. Remote work with occasional travel to Humana offices may be required.