Remote Medical Director – Medicare Appeals (Part-Time)

Humana, Inc.; Boise (ID); Remote; USD 224,000 - 313,000; Part time

Benefits offered by this job

Payment for hourly compensation

Remote work flexibility

Professional development opportunities

Job summary

The Medical Director at Humana relies on broad clinical expertise to review Medicare drug appeals (Part D and B). The role is part-time, seasonal with flexible weekly hours and compensated hourly, working to support value-based care within Medicare and Humana policy.

Collaboration with clinicians and staff is essential to ensure optimal member outcomes. Requirements include an MD or DO, an unrestricted license, board certification, and strong communication and analytic skills.

Qualifications

• MD or DO degree and an unrestricted license in at least one jurisdiction.
• Current and ongoing Board Certification with preference for internal medicine, family medicine, emergency medicine or PM&R.
• No current sanction from federal or state authorities and able to pass credentialing.
• Excellent verbal and written communication skills; strong analytic abilities.
• Experience in teams focusing on quality or utilization management is a plus.

Responsibilities

• Review Medicare drug appeals (Part D and B) with broad clinical expertise.
• Collaborate with clinicians and staff to ensure value-based care.
• Operate within Medicare rules, Humana policies, and regulatory guidelines.
• Participate in teams focused on quality management and utilization management.

Skills

Excellent communication

Analytic skills

Team collaboration

Quality management

Education

MD or DO degree

Board Certification

Unrestricted medical license

Job description

The Medical Director at Humana relies on broad clinical expertise to review Medicare drug appeals (Part D and B). The role is part-time, seasonal with flexible weekly hours and compensated hourly, working to support value-based care within Medicare and Humana policy.

Collaboration with clinicians and staff is essential to ensure optimal member outcomes. Requirements include an MD or DO, an unrestricted license, board certification, and strong communication and analytic skills.