Part-Time Medicare Drug Appeals Director (Remote)

Humana, Inc.; Boston (MA); Remoto; USD 224.000 - 313.000; Part-time

Vantaggi offerti da questo lavoro

Paid time off

401(k) retirement savings plan

Employee assistance program

Business travel

Descrizione del lavoro

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

The position emphasizes regulatory compliance, collaboration with clinicians, and value-based care aligned with Humana policies and CMS guidance. Ideal candidates hold an MD/DO, a valid license, and Board Certification in relevant specialties, with strong communication and analytical skills.

Competenze

• MD or DO degree required.
• Current and unrestricted license in at least one jurisdiction; willing to obtain additional license 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 with experience in quality management or utilization management.

Mansioni

• Review Medicare drug appeals (Part D and Part B).
• Collaborate with clinicians and support staff to provide value-based care within regulatory requirements.
• Perform computer-based review of moderately complex to complex appeals for coverage using CMS policies and Humana guidelines.

Conoscenze

Verbal communication

Written communication

Analytic thinking

Team collaboration

Formazione

MD or DO degree

Board Certification: Internal/Family/Emergency/PM&R

Descrizione del lavoro

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

The position emphasizes regulatory compliance, collaboration with clinicians, and value-based care aligned with Humana policies and CMS guidance. Ideal candidates hold an MD/DO, a valid license, and Board Certification in relevant specialties, with strong communication and analytical skills.