Remote Medical Director — Medicare Drug Appeals

Humana Inc; Lansing (MI); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana Inc. is seeking a Medical Director to review Medicare drug appeals (Part D and B) and ensure compliance with Medicare rules and Humana policies. You will collaborate with clinicians to support value-based care for Humana members.

The role requires an MD/DO, ongoing board certification, and a current unrestricted license, plus strong analytic, communication, and teamwork skills; it is remote with travel as needed.

Qualifications

• MD or DO degree required.
• 5+ years direct clinical patient care since doctorate.
• Board certification with preferred specialties.
• Current physician license in at least one jurisdiction.
• Willing to obtain additional licenses if required.
• Strong verbal and written communication skills.
• Analytic/interpretation skills with QA/utilization management experience.

Responsibilities

• Review Medicare drug appeals (Part D & B) using Medicare rules and Humana policies.
• Perform computer-based review of coverage appeals for drugs.
• Peer to Peer discussions with prescribers and ALJ hearings.
• Support CMS audits and cross-functional team activities.
• Collaborate to provide value-based care for Humana members.

Skills

Clinical patient care

Medicare knowledge

Communication skills

Analytic thinking

Team collaboration

Credentialing

Education

MD or DO degree

Board Certification

Job description

Humana Inc. is seeking a Medical Director to review Medicare drug appeals (Part D and B) and ensure compliance with Medicare rules and Humana policies. You will collaborate with clinicians to support value-based care for Humana members.

The role requires an MD/DO, ongoing board certification, and a current unrestricted license, plus strong analytic, communication, and teamwork skills; it is remote with travel as needed.