Description
We are seeking a part-time, seasonal Medical Director to review Medicare drug appeals. As a Medical Director, you will rely on your broad clinical expertise to analyse complex issues and make determinations in accordance with Medicare rules, Humana policies, and medical necessity.
The Medical Director will collaborate with clinicians and support staff to provide optimal value-based care to Humana members. You will work in a remote setting, utilising computer-based review tools and resources such as CMS policies, National and Local Coverage Determinations, and clinical literature.
Responsibilities:
- Review moderately complex to complex appeals for coverage for drugs
- Analyse situations or data on a case-by-case basis, considering Medicare rules, Humana policies, and medical necessity
- Collaborate with clinicians and support staff to provide optimal value-based care
- Utilise computer-based review tools and resources
Requirements:
- MD or DO degree
- Current and unrestricted license in at least one jurisdiction
- Current and ongoing Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or Physical Medicine and Rehabilitation
- Excellent verbal and written communication skills
- Evidence of analytic and interpretation skills
Preferred Qualifications:
- Knowledge of the managed care industry
- Utilization management experience in a medical management review organisation
- 5+ years of direct clinical patient care experience post-residency or fellowship
- Experience with national guidelines such as MCG, InterQual, NCCN, Micromedex, Lexicomp, Elsevier's Clinical Pharmacology
Benefits:
- Paid time off
- 401(k) retirement savings plan
- Employee assistance program
- Business travel and accident insurance
Work Arrangements:
- Remote work arrangement with occasional travel to Humana offices for training or meetings
- Must have a dedicated workspace with minimal interruptions to protect member PHI/HIPAA information
- Reliable internet connection with a minimum download speed of 25 Mbps and upload speed of 10 Mbps
Compensation:
- The compensation range for this position is $223,800 - $313,100 per year