Remote Part-Time Medical Director — Medicare Appeals

Humana, Inc.; Salt Lake City (UT); Remote; USD 224,000 - 313,000; Part time

Benefits offered by this job

Flexible weekly hours

Remote work option

Job summary

Humana, Inc. is seeking a part-time, seasonal Medical Director to review Medicare drug appeals (Part D and B). You will apply broad clinical expertise to complex cases, collaborating with clinicians to deliver value-based care while aligning with Medicare rules and Humana policies.

Responsibilities include computer-based review of complex appeals, contributing to quality and utilization management initiatives, and supporting regulatory compliance. Travel may be required occasionally.

Qualifications

• MD or DO degree required.
• Current and unrestricted license in at least one jurisdiction.
• Board Certification with preference for Internal Medicine, Family Medicine, Emergency Medicine or Physical Medicine and Rehabilitation.
• No sanctions from Federal or State agencies; credentialing pass required.
• 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) with broad clinical expertise.
• Collaborate with clinicians and staff to support value-based care.
• Operate within Medicare/Humana policies and regulatory requirements.
• Perform computer-based reviews of complex appeals using established resources.

Skills

MD/DO degree

Medical license

Board certification

Communication skills

Analytic skills

Education

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

Job description

Humana, Inc. is seeking a part-time, seasonal Medical Director to review Medicare drug appeals (Part D and B). You will apply broad clinical expertise to complex cases, collaborating with clinicians to deliver value-based care while aligning with Medicare rules and Humana policies.

Responsibilities include computer-based review of complex appeals, contributing to quality and utilization management initiatives, and supporting regulatory compliance. Travel may be required occasionally.