Remote Part-Time Medical Director - Medicare Appeals

Humana, Inc.; Pierre (SD); Remote; USD 224,000 - 313,000; Part time

Job summary

Humana, Inc. is seeking a Medical Director for a part-time, seasonal role that is non-benefitted and compensated hourly. The Medical Director will review Medicare drug appeals (Part D and B) and collaborate with clinicians to support value-based care under Medicare and Humana policy.

The role involves complex data analysis, regulatory compliance, and using CMS policies, NCCN, and Humana guidelines. Travel is occasional, and remote work is allowed with variable weekly hours.

Qualifications

• MD or DO degree
• Current and unrestricted license in at least one jurisdiction
• Board Certification with preference for 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) for coverage decisions
• Collaborate with clinicians and staff to provide value-based care
• Apply CMS policies, National Coverage Determinations, NCCN and Humana guidelines
• Operate within regulatory compliance and use available resources

Skills

MD/DO

Medical license

Board certification

Communication skills

Analytical skills

Education

MD/DO degree

Job description

Humana, Inc. is seeking a Medical Director for a part-time, seasonal role that is non-benefitted and compensated hourly. The Medical Director will review Medicare drug appeals (Part D and B) and collaborate with clinicians to support value-based care under Medicare and Humana policy.

The role involves complex data analysis, regulatory compliance, and using CMS policies, NCCN, and Humana guidelines. Travel is occasional, and remote work is allowed with variable weekly hours.