Remote Medical Director for Medicare Appeals

Humana, Inc.; Bismarck (ND); À distance; USD 224 000 - 313 000; Temps partiel

Résumé du poste

Humana, Inc. is seeking a Medical Director for a part-time, seasonal role with flexible weekly hours.

The position is non-benefitted and compensated hourly, focusing on review of Medicare drug appeals (Part D and B) and collaboration with clinicians to ensure optimal value-based care within Humana policy. The successful candidate will hold an MD or DO, maintain an unrestricted medical license, and possessBoard Certification in relevant specialties.

Qualifications

• MD or DO degree required.
• Current and unrestricted license in at least one jurisdiction, with willingness to obtain additional licenses if required.
• Board Certification with preference for Internal Medicine, Family Medicine, Emergency Medicine or PM&R.
• 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/utilization management teams.

Responsabilités

• Review Medicare drug appeals (Part D and B) using Humana policies and medical necessity guidelines.
• Collaborate with clinicians and staff to deliver value-based care.
• Operate within regulatory compliance and use CMS policies, determinations, and clinical literature as appropriate.
• Perform computer-based reviews of complex drug coverage appeals and support related processes.

Connaissances

Verbal communication

Written communication

Analytic interpretation

Team collaboration

Formation

MD or DO degree

Unrestricted license

Board Certification in Internal Medicine / Family Medicine / Emergency Medicine / PM&R

Description du poste

Humana, Inc. is seeking a Medical Director for a part-time, seasonal role with flexible weekly hours.

The position is non-benefitted and compensated hourly, focusing on review of Medicare drug appeals (Part D and B) and collaboration with clinicians to ensure optimal value-based care within Humana policy. The successful candidate will hold an MD or DO, maintain an unrestricted medical license, and possessBoard Certification in relevant specialties.