Remote Medical Director for Medicare Appeals (Part-Time)

Humana, Inc.; Juneau (AK); Remote; USD 224,000 - 313,000; Part time

Job summary

Humana, Inc. is seeking a part-time Medical Director to review Medicare drug appeals (Part D and B) and help deliver value-based care.

You will collaborate with clinicians and staff within a regulated framework, using CMS policies, NCCN, Humana Pharmac policies, and clinical literature to guide decisions. The role requires MD/DO with active licensure, board certification, and strong analytical and communication skills.

Qualifications

• MD or DO degree and active license.
• Current and unrestricted license in at least one jurisdiction.
• Board Certification in Internal/Family/Emergency or PM&R preferred.
• No sanctions; able to pass credentialing.
• Excellent verbal and written communication.
• Experience in quality/utilization management teams.

Responsibilities

• Review Medicare drug appeals (Part D and B).
• Collaborate with clinicians and staff to support value-based care.
• Operate within Medicare and Humana policies and regulatory requirements.
• Leverage CMS policies, NCCN, and Humana Clinical references as needed.

Skills

Verbal communication

Written communication

Analytical skills

Team collaboration

Credentialing knowledge

Education

MD or DO degree

Active license in at least one jurisdiction

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

Job description

Humana, Inc. is seeking a part-time Medical Director to review Medicare drug appeals (Part D and B) and help deliver value-based care.

You will collaborate with clinicians and staff within a regulated framework, using CMS policies, NCCN, Humana Pharmac policies, and clinical literature to guide decisions. The role requires MD/DO with active licensure, board certification, and strong analytical and communication skills.