Remote Part-Time Medical Director — Medicare Appeals

Humana, Inc.; Annapolis (MD); Remote; USD 224,000 - 313,000; Part time

Job summary

Humana, Inc. is seeking a Medical Director for a part-time seasonal role. The job focuses on reviewing Medicare drug appeals with access to diverse resources and requires broad clinical expertise and licensure across jurisdictions.

The role emphasizes collaboration with clinicians and adherence to Medicare and Humana policies to achieve value-based care while navigating regulatory requirements. Familiarity with CMS guidance is beneficial.

Qualifications

• MD or DO with an unrestricted medical license in at least one jurisdiction.
• Board certification with preference for major internal medicine subspecialties.
• Ability to pass credentialing requirements and maintain licensure.

Responsibilities

• Review Medicare drug appeals (Part D and B) with complex to highly complex issues.
• Collaborate with clinicians and staff to support value-based care.
• Comply with Medicare rules, Humana policies and regulatory requirements.
• Operate with an emphasis on quality management and utilization review.

Skills

Verbal communication

Written communication

Analytical skills

Team collaboration

Education

MD or DO degree

Medical license (unrestricted)

Board Certification (Internal Medicine / Family Medicine / Emergency Medicine / PM&R)

Job description

Humana, Inc. is seeking a Medical Director for a part-time seasonal role. The job focuses on reviewing Medicare drug appeals with access to diverse resources and requires broad clinical expertise and licensure across jurisdictions.

The role emphasizes collaboration with clinicians and adherence to Medicare and Humana policies to achieve value-based care while navigating regulatory requirements. Familiarity with CMS guidance is beneficial.