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About the role
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- MD or DO degree
- 5+ years of direct clinical patient care experience post completion of doctorate, preferably including some experience related to a Medicare type population (disabled or >65 years of age)
- Current and ongoing Board Certification with preference for Internal Medicine, Family Medicine, Emergency Medicine or Physical Medicine and Rehabilitation
- A current and unrestricted physician license in at least one jurisdiction and willing to obtain additional license, if required
- No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
- Excellent verbal and written communication skills
More about this role
The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director works assignments involve that moderately complex to complex issues where the analysis of situations or data requires a case-by-case consideration of the Medicare rules, Humana policies and medical necessity.
The Medical Director's work includes computer-based review of moderately complex to complex appeals for coverage for drugs using resources outlined above as well as inter- and intra-departmental resources. Work may include Peer to Peer discussions with prescribers, participation in hearings involving an Administrative Law Judge, support for CMS audits, cross-functional team activities, and other responsibilities as determined necessary to support optimal value-based care in accordance with Medicare rules.
The Medical Director will collaborate with clinicians and support staff to provide Humana members with optimal value-based care in accordance with Medicare and Humana policy. All work occurs within a context of regulatory compliance and work is assisted by diverse resources, included but not limited to CMS policies, National and Local Coverage...
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