Remote Medicare Medical Director: Value-Based Care Leader

Humana Inc; Augusta (ME); Remote; USD 224,000 - 313,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Medical Director to review Medicare drug appeals (Part D & B) and guide value-based care. You will analyze complex cases using Medicare rules, Humana policies, and medical necessity, collaborating across departments to support optimal outcomes for members.

The role requires an MD or DO with 5+ years of clinical experience, board certification, and a current medical license. Travel to training or meetings may be required; remote work is possible.

Qualifications

• MD or DO degree required.
• 5+ years of direct clinical patient care post doctorate.
• Board certification in Internal Medicine, Family Medicine, Emergency Medicine or PM&R preferred.
• Active physician license in at least one state, willing to obtain more if needed.
• No current sanctions; able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills with quality/utilization experience.

Responsibilities

• Review Medicare drug appeals (Part D & B) via computer-based review.
• Collaborate with clinicians and support staff to provide value-based care.
• Participate in peer-to-peer discussions with prescribers and in CMS-related activities.
• Support audits and cross-functional team work as needed.

Skills

Clinical experience

Board certification

Licensed physician

Communication skills

Analytic skills

Team collaboration

Education

MD or DO degree

Job description

Humana Inc. is seeking a Medical Director to review Medicare drug appeals (Part D & B) and guide value-based care. You will analyze complex cases using Medicare rules, Humana policies, and medical necessity, collaborating across departments to support optimal outcomes for members.

The role requires an MD or DO with 5+ years of clinical experience, board certification, and a current medical license. Travel to training or meetings may be required; remote work is possible.