Remote Medical Director: Medicare Appeals (Part-Time)

Humana, Inc.; Phoenix (AZ); Remote; USD 224,000 - 313,000; Part time

Job summary

Humana, Inc. is seeking a Medical Director for a part-time, seasonal role focused on reviewing Medicare drug appeals (Part D and B). The position operates with flexible weekly hours and is compensated hourly, with remote travel to Humana offices as needed.

The Medical Director will work with clinicians to ensure appropriate, value-based care under Medicare and Humana policies. The role requires an MD or DO, an unrestricted license, board certification in relevant fields, and demonstrated

Qualifications

• MD or DO degree is required.
• Current and unrestricted license in at least one jurisdiction and willingness to obtain additional licenses.
• 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 experience in quality/utilization management.

Responsibilities

• Review Medicare drug appeals (Part D and B) for coverage decisions.
• Collaborate with clinicians and staff to provide value-based care within regulatory and policy frameworks.
• Utilize CMS policies, NCCN, Humana policies and clinical literature to inform decisions.

Skills

Unrestricted license

Board certification

Excellent communication

Analytical skills

Team collaboration

Education

MD or DO degree

Job description

Humana, Inc. is seeking a Medical Director for a part-time, seasonal role focused on reviewing Medicare drug appeals (Part D and B). The position operates with flexible weekly hours and is compensated hourly, with remote travel to Humana offices as needed.

The Medical Director will work with clinicians to ensure appropriate, value-based care under Medicare and Humana policies. The role requires an MD or DO, an unrestricted license, board certification in relevant fields, and demonstrated