Remote Medical Director - Part-Time, Seasonal

Humana, Inc.; Lincoln (NE); Remote; USD 224,000 - 313,000; Part time

Job summary

The Medical Director at Humana, Inc. is a part-time, seasonal role with variable weekly hours and no benefits, compensated hourly.

The position focuses on reviewing Medicare drug appeals (Part D and B) and making complex determinations in line with Medicare rules, Humana policies, and medical necessity. Collaborating with clinicians and staff, you will help ensure value-based care while maintaining compliance with CMS guidelines, NCCN, and Humana procedures.

Qualifications

• MD or DO degree.
• Current and unrestricted license in at least one jurisdiction; willing to obtain additional license 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 participating in teams focusing on quality management, utilization management, or similar activities.

Responsibilities

• Review Medicare drug appeals (Part D and B) with broad clinical expertise.
• Collaborate with clinicians and support staff to provide Humana members with value-based care.
• Review and apply Medicare rules and Humana policies to determine medical necessity.
• Utilize CMS policies, NCCN, Humana Procedures and clinical literature to inform decisions.
• Work within a regulatory-compliant framework and support value-based care initiatives.

Skills

Excellent verbal and written comms

Analytic interpretation skills

Team collaboration

Education

MD or DO degree

Current unrestricted license

Board Certification in Internal/Family/Emergency/PM&R

Tools

Credentialing processes

Job description

The Medical Director at Humana, Inc. is a part-time, seasonal role with variable weekly hours and no benefits, compensated hourly.

The position focuses on reviewing Medicare drug appeals (Part D and B) and making complex determinations in line with Medicare rules, Humana policies, and medical necessity. Collaborating with clinicians and staff, you will help ensure value-based care while maintaining compliance with CMS guidelines, NCCN, and Humana procedures.