Remote Medical Director, Medicare Appeals (Part-Time)

Humana, Inc.; Augusta (ME); Remote; USD 224.000 - 313.000; Teilzeit

Zusammenfassung

Humana, Inc. invites a Medical Director to join a part-time, seasonal role reviewing Medicare drug appeals (Part D and B). The position is remote with occasional travel to Humana offices; hours are flexible and compensation is hourly, non-benefitted.

You will collaborate with clinicians to ensure value-based care, using CMS policies and clinical literature. Requires MD or DO, unrestricted license, Board Certification, and strong analytic skills.

Qualifikationen

• MD or DO degree is required.
• A current and unrestricted license in at least one jurisdiction and willingness to obtain additional licenses 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, and able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills, with prior experience in quality management or utilization management activities.

Aufgaben

• Review Medicare drug appeals (Part D and B) with increasing complexity.
• Collaborate with clinicians and support staff to provide value-based care in line with Medicare and Humana policy.
• Apply Medicare rules, CMS guidance, and Humana policies to case decisions.
• Support quality and utilization management initiatives and participate in team-based reviews.

Kenntnisse

Verbal and written communication

Analytic skills

Team collaboration

Credentialing experience

Ausbildung

MD or DO degree

Jobbeschreibung

Humana, Inc. invites a Medical Director to join a part-time, seasonal role reviewing Medicare drug appeals (Part D and B). The position is remote with occasional travel to Humana offices; hours are flexible and compensation is hourly, non-benefitted.

You will collaborate with clinicians to ensure value-based care, using CMS policies and clinical literature. Requires MD or DO, unrestricted license, Board Certification, and strong analytic skills.