Remote Part-Time Medical Director: Medicare Appeals

Humana, Inc.; Honolulu (HI); Remote; USD 83,000 - 179,000; Part time

Job summary

Humana, Inc. seeks a Medical Director for a part-time, seasonal, remote role to review Medicare drug appeals (Part D and B) and support value-based care within regulatory guidelines.

The role collaborates with clinicians to optimize member outcomes and ensure compliance with CMS policies and Humana procedures. The position requires an MD/DO, an unrestricted license, board certification in relevant specialties, and strong communication and analytical skills; prior utilization or quality

Qualifications

• MD or DO degree with full medical license.
• Current, unrestricted medical license in at least one jurisdiction; willingness to obtain additional licenses as required.
• Board Certification with preference for Internal Medicine, Family Medicine, Emergency Medicine or PM&R.
• No current sanctions and ability to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Analytic interpretation skills with experience in quality/ utilization management teams.

Responsibilities

• Review Medicare drug appeals (Part D and Part B) using Humana policies and Medicare rules.
• Collaborate with clinicians and staff to ensure compliant, value-based care.
• Perform computer-based review of moderately to complex appeals for coverage decisions.
• Engage with cross-functional resources to support regulatory compliance and clinical literature.

Skills

Verbal communication

Written communication

Analytical skills

Team collaboration

Problem solving

Education

MD/DO

Medical license

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

Job description

Humana, Inc. seeks a Medical Director for a part-time, seasonal, remote role to review Medicare drug appeals (Part D and B) and support value-based care within regulatory guidelines.

The role collaborates with clinicians to optimize member outcomes and ensure compliance with CMS policies and Humana procedures. The position requires an MD/DO, an unrestricted license, board certification in relevant specialties, and strong communication and analytical skills; prior utilization or quality