Remote Part-Time Medical Director: Medicare Appeals

Humana, Inc.; Richmond (VA); Remote; USD 224,000 - 313,000; Part time

Job summary

Humana, Inc. is seeking a Medical Director for a part-time, seasonal role to review Medicare drug appeals (Part D and B). The position requires an MD or DO, a current medical license, and board certification in Internal Medicine, Family Medicine, Emergency Medicine, or PM&R.

This remote role may involve some travel for training and meetings. Work involves collaborating with clinicians to ensure value-based care within Humana policies and regulatory guidelines.

Qualifications

• MD or DO degree.
• A current and unrestricted license in at least one jurisdiction and 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, and able to pass credentialing requirements
• Excellent verbal and written communication skills
• Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, or similar activities

Responsibilities

• Review Medicare drug appeals (Part D and B).
• Collaborate with clinicians and staff to provide value-based care.
• Work within regulatory compliance and Humana policy.
• Utilize CMS policies and recognized guidelines in daily work.
• Perform computer-based reviews of complex drug coverage appeals.
• Support other duties to optimize value-based care.

Skills

Communication skills

Analytical skills

Team collaboration

Problem solving

Leadership

Education

MD/DO degree

Medical license

Board Certification in Internal Medicine/Family Medicine/Emergency Medicine/PM&R

Job description

Humana, Inc. is seeking a Medical Director for a part-time, seasonal role to review Medicare drug appeals (Part D and B). The position requires an MD or DO, a current medical license, and board certification in Internal Medicine, Family Medicine, Emergency Medicine, or PM&R.

This remote role may involve some travel for training and meetings. Work involves collaborating with clinicians to ensure value-based care within Humana policies and regulatory guidelines.