Remote Medical Director - Medicare Appeals

Humana Inc; Frankfort (KY); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Medical Director to oversee Medicare drug appeals (Part D & B). You will review complex cases, collaborate with clinicians, and ensure value-based care in line with Medicare rules and Humana policies.

The role requires MD/DO, 5+ years clinical experience post-licensure, board certification, and a valid license. Remote work possible with occasional travel; 40 weekly hours; base pay $223,800 to $313,100 per year; bonus plan available.

Qualifications

• MD or DO degree required.
• 5+ years of direct clinical patient care after doctorate.
• Board Certification with preference for Internal Medicine, Family Medicine, Emergency Medicine or Physical Medicine and Rehabilitation.
• Current and unrestricted physician license in at least one jurisdiction.
• 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 in quality/utilization management teams.

Responsibilities

• Review Medicare drug appeals (Part D & B) for coverage of drugs.
• Collaborate with clinicians and departments to support value-based care.
• Engage in peer discussions, hearings, audits, and cross-functional activities as needed.

Skills

Communication skills

Analytic skills

Team collaboration

Quality management experience

Education

MD or DO degree

Job description

Humana Inc. is seeking a Medical Director to oversee Medicare drug appeals (Part D & B). You will review complex cases, collaborate with clinicians, and ensure value-based care in line with Medicare rules and Humana policies.

The role requires MD/DO, 5+ years clinical experience post-licensure, board certification, and a valid license. Remote work possible with occasional travel; 40 weekly hours; base pay $223,800 to $313,100 per year; bonus plan available.