Medical Director – Medicare Pharmacy, VSP

Become a part of our caring community

=========================================

The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve 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.

Please note that this Medical Director position is non-benefitted, and compensated hourly** 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 Determinations, CMS-recognized Compendia, NCCN, Humana Pharmacy Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D and Medicare Advantage requirements and will understand how to operationalize this in their daily work.

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 other responsibilities as determined necessary to support optimal value-based care in accordance with Medicare and Humana policy.

* Please note that this Medical Director position is a part-time, seasonal position, with variable/flexible weekly hours. The position is non-benefited, and compensated hourly

Use your skills to make an impact

=====================================

Required Qualifications

• MD or DO degree
• A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required
• Current and ongoing Board Certification with preference f