Remote Part-Time Medical Director: Medicare Appeals

Humana, Inc.; Salem (OR); Remote; USD 224,000 - 313,000; Part time

Job summary

Humana, Inc. seeks a part-time, seasonal Medical Director to review Medicare drug appeals, applying broad clinical expertise to moderately to complex cases. The role supports value-based care within Medicare and Humana policy, collaborating with clinicians and staff to ensure compliant decisions.

The position emphasizes learning Medicare Part D and MA requirements, credentialing, and participation in team-based quality and utilization activities, with flexibility in hours and non-benefit status.

Qualifications

• MD or DO degree required.
• Active, unrestricted license in at least one jurisdiction; willingness to obtain additional licenses as needed.
• Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or Physical Medicine and Rehabilitation preferred.
• No current sanctions from Federal or State authorities; able to pass credentialing requirements.

Responsibilities

• Review Medicare drug appeals (Part D and B) with broad clinical expertise.
• Collaborate with clinicians and staff to support value-based care compliant with Medicare and Humana policy.
• Learn Medicare Part D and MA requirements and operationalize them in daily work.
• Perform computer-based reviews of complex drug coverage appeals and support related responsibilities as needed.

Skills

Verbal communication

Written communication

Analytical skills

Team collaboration

Quality/Utilization management

Education

MD or DO degree

Job description

Humana, Inc. seeks a part-time, seasonal Medical Director to review Medicare drug appeals, applying broad clinical expertise to moderately to complex cases. The role supports value-based care within Medicare and Humana policy, collaborating with clinicians and staff to ensure compliant decisions.

The position emphasizes learning Medicare Part D and MA requirements, credentialing, and participation in team-based quality and utilization activities, with flexibility in hours and non-benefit status.