Remote Part-Time Medical Director, Medicare Appeals

Humana, Inc.; Topeka (KS); Remote; USD 224,000 - 313,000; Part time

Benefits offered by this job

Paid time off

401(k) retirement savings plan

Remote position

Job summary

Humana, Inc. is seeking a Medical Director for a part-time, seasonal, non-benefitted remote role. The position involves reviewing Medicare drug appeals (Part D and B) with broad clinical expertise and collaboration with clinicians to support value-based care.

Duties include complex to moderately complex case reviews, credentialing, and adherence to Humana policies and CMS guidelines. Required are an MD or DO with an unrestricted license, board certification (Internal/Family/Emergency/PM&R

Qualifications

• MD or DO degree 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
• Experience in quality management or utilization management teams

Responsibilities

• Review Medicare drug appeals (Part D and B) with broad clinical expertise
• Collaborate with clinicians and support staff to provide value-based care
• Operate within regulatory compliance using CMS policies and clinical literature
• Utilize resources such as NCCN, Humana policies and procedures in day-to-day review
• Participate in teams focusing on quality management and utilization management

Skills

MD or DO licensure

Board Certification

Analytic interpretation skills

Excellent communication

Credentialing experience

Regulatory compliance knowledge

Education

MD or DO degree

Job description

Humana, Inc. is seeking a Medical Director for a part-time, seasonal, non-benefitted remote role. The position involves reviewing Medicare drug appeals (Part D and B) with broad clinical expertise and collaboration with clinicians to support value-based care.

Duties include complex to moderately complex case reviews, credentialing, and adherence to Humana policies and CMS guidelines. Required are an MD or DO with an unrestricted license, board certification (Internal/Family/Emergency/PM&R