Remote Part-Time Medical Director — Medicare Appeals

Humana, Inc.; Lansing (MI); Remote; USD 60,000 - 100,000; Part time

Job summary

Humana, Inc. is seeking a part-time Medical Director to review Medicare drug appeals (Part D and B) and support value-based care initiatives.

The role involves collaboration with clinicians and staff within a compliant framework, utilizing CMS policies, NCCN, and Humana guidelines to inform decisions. The ideal candidate will hold an MD/DO, maintain licensure, have board certification in relevant fields, and demonstrate strong communication and analytical skills.

Qualifications

• MD or DO degree.
• Unrestricted license in at least one jurisdiction and willingness to obtain additional license.
• Board Certification preferred: Internal Medicine, Family Medicine, Emergency Medicine or PM&R.
• 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 experience in quality/utilization management.

Responsibilities

• Review Medicare drug appeals (Part D and B).
• Collaborate with clinicians and staff to provide value-based care.
• Operate within regulatory compliance and use CMS policies and clinical literature as guidance.
• Learn Medicare Part D and Medicare Advantage requirements and apply them daily.
• Perform computer-based review of complex drug coverage appeals using available resources.

Skills

Excellent verbal and written comm.

Analytic and interpretation skills

Team collaboration

Education

MD or DO degree

Job description

Humana, Inc. is seeking a part-time Medical Director to review Medicare drug appeals (Part D and B) and support value-based care initiatives.

The role involves collaboration with clinicians and staff within a compliant framework, utilizing CMS policies, NCCN, and Humana guidelines to inform decisions. The ideal candidate will hold an MD/DO, maintain licensure, have board certification in relevant fields, and demonstrate strong communication and analytical skills.