Remote Part-Time Medical Director: Medicare Appeals

Humana, Inc.; Madison (WI); Remote; USD 224,000 - 313,000; Part time

Benefits offered by this job

401(k) plan

Paid time off

Flexible weekly hours

Job summary

Humana, Inc. seeks a Medical Director for a part-time, seasonal role reviewing Medicare drug appeals (Part D and B). The position offers flexible weekly hours, is non-benefitted, and paid hourly. You will collaborate with clinicians to support value-based care, guided by Medicare rules, Humana policies and clinical literature.

Responsibilities include computer-based reviews of complex appeals and cross‑department collaboration to ensure optimal member outcomes.

Qualifications

• MD or DO with unrestricted license.
• Willing to obtain additional license if required.
• Board certification preferred in Internal Medicine, Family Medicine, Emergency Medicine or PM&R.
• No current sanctions and able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Analytic and interpretation skills with experience in quality/utilization management.

Responsibilities

• Review Medicare drug appeals (Part D and B).
• Collaborate with clinicians to support value-based care.
• Operate under Medicare rules and Humana policies with appropriate literature support.
• Handle moderately to complex case reviews and documentation.
• Support cross-department efforts to optimize member outcomes.

Skills

Excellent verbal and written skills

Analytic and interpretation skills

Team collaboration

Education

MD/DO degree

Unrestricted medical license

Tools

Medicare guidelines (MCG, InterQual, NCCN)

Clinical pharmacology references (Lexicomp, Micromedex)

Job description

Humana, Inc. seeks a Medical Director for a part-time, seasonal role reviewing Medicare drug appeals (Part D and B). The position offers flexible weekly hours, is non-benefitted, and paid hourly. You will collaborate with clinicians to support value-based care, guided by Medicare rules, Humana policies and clinical literature.

Responsibilities include computer-based reviews of complex appeals and cross‑department collaboration to ensure optimal member outcomes.