Remote Medical Director - Medicare Appeals Lead

Humana, Inc.; Pierre (SD); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement savings plan

Paid time off

Job summary

Humana, Inc. is seeking a Medical Director to review Medicare drug appeals (Part D & B) and support value-based care within a compliant framework. You will collaborate with clinicians, participate in CMS hearings, and support audits using Humana policies and Medicare guidelines.

The role requires MD/DO, 5+ years of clinical care, and board certification with licensure in at least one jurisdiction, plus strong communication and analytical skills. Remote with travel as needed.

Qualifications

• MD/DO degree and physician license in at least one jurisdiction
• 5+ years of direct clinical patient care experience post doctorate
• Current and ongoing Board Certification; preferred: Internal Medicine, Family Medicine, Emergency Medicine, or Physical Medicine and Rehabilitation
• Excellent verbal and written communication skills
• Evidence of analytic and interpretation skills; experience with quality/utilization management teams

Responsibilities

• Review Medicare drug appeals (Part D & B) using Medicare rules and Humana policies
• Collaborate with clinicians and support staff to provide value-based care
• Participate in hearings, CMS audits, and cross-functional team activities
• Operate in a compliant environment with access to CMS policies, NCCN, and Humana procedures

Skills

Board certification

Clinical patient care

Analytic interpretation

Communication skills

Education

MD or DO degree

Job description

Humana, Inc. is seeking a Medical Director to review Medicare drug appeals (Part D & B) and support value-based care within a compliant framework. You will collaborate with clinicians, participate in CMS hearings, and support audits using Humana policies and Medicare guidelines.

The role requires MD/DO, 5+ years of clinical care, and board certification with licensure in at least one jurisdiction, plus strong communication and analytical skills. Remote with travel as needed.