Remote Part-Time Medical Director, Medicare Appeals

Humana, Inc.; Carson City (NV); Remote; USD 224,000 - 313,000; Part time

Job summary

Humana, Inc. is seeking a Medical Director for a part-time, seasonal role focused on reviewing Medicare drug appeals (Part D and B). The position involves licensed physicians with board certification, strong analytical skills, and expertise in a value-based care framework within Humana policy and CMS guidelines.

The role is remote with travel to Humana offices as needed. It requires an active medical license, ongoing credentialing, and ability to manage complex cases while collaborating with

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; able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills; experience in quality or utilization management.

Responsibilities

• Review Medicare drug appeals (Part D and B) for coverage decisions; analyze complex cases.
• Collaborate with clinicians and staff to provide value-based care per Medicare and Humana policy.
• Learn Medicare Part D and MA requirements and operationalize them in daily work.
• Perform computer-based reviews of moderately to complex appeals for drug coverage; utilize CMS policies and clinical literature.

Skills

Communication skills

Analytical skills

Credentialing requirements

Team collaboration

Quality focus

Education

MD/DO degree

Job description

Humana, Inc. is seeking a Medical Director for a part-time, seasonal role focused on reviewing Medicare drug appeals (Part D and B). The position involves licensed physicians with board certification, strong analytical skills, and expertise in a value-based care framework within Humana policy and CMS guidelines.

The role is remote with travel to Humana offices as needed. It requires an active medical license, ongoing credentialing, and ability to manage complex cases while collaborating with