Remote Medical Director - Medicare Drug Appeals

Humana Inc. is seeking a Medical Director to oversee Medicare drug appeals (Part D & B) with broad clinical expertise.

The role involves reviewing complex cases, using Medicare rules, Humana policies, and medical necessity criteria, and collaborating with clinicians and other teams to ensure value-based care. Responsibilities include computer-based case reviews, peer-to-peer discussions, support for CMS audits, and cross-functional activities.