Remote Medical Director — Medicare & Value-Based Care

Humana Inc; Madison (WI); Remote; USD 224,000 - 313,000; Full time

Job summary

Humana Inc. is seeking a Medical Director to review Medicare drug appeals (Part D & B) and support value-based care within Medicare guidelines. The role involves collaboration with clinicians, cross-functional teams, and participation in hearings and audits to ensure compliant, high-quality patient care.

Ideal candidates hold an MD or DO, board certification, and an active physician license. The position is remote with travel, offering a competitive annual salary and a comprehensive benefits

Qualifications

• MD or DO degree and board certification.
• 5+ years of direct clinical patient care experience post doctorate.
• Current unrestricted physician license in at least one jurisdiction.

Responsibilities

• Review Medicare drug appeals (Part D & B) using Medicare rules and Humana policies.
• Collaborate with clinicians and staff to provide value-based care.
• Participate in hearings, CMS audits, and inter-departmental activities.
• Support quality management and utilization management efforts.

Skills

Verbal communication

Written communication

Analytical skills

Team collaboration

Leadership

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 Medicare guidelines. The role involves collaboration with clinicians, cross-functional teams, and participation in hearings and audits to ensure compliant, high-quality patient care.

Ideal candidates hold an MD or DO, board certification, and an active physician license. The position is remote with travel, offering a competitive annual salary and a comprehensive benefits