Humana Pharmacy Solutions, Inc.Hiring

Medical Director National OP, Medicare

  • Remote, worldwide
  • Full-time
  • Lead
  • Posted 8 days ago
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In one line

Clinical role reviewing preauthorization requests and ensuring compliance with Medicare and Medicare Advantage requirements.

About the role

The role involves analyzing clinical scenarios, communicating decisions, and collaborating with internal and external stakeholders to support regional market priorities.

At a glance

Pay
Not stated in the posting
Remote scope
Remote, worldwide
Seniority
Lead
Employment
Full-time
Skills
Medicare, Care management
Posted
21 Oct 2026
Last checked
28 Oct 2026

What you will do

  • Review preauthorization requests for services and determine compliance with guidelines.
  • Communicate decisions to internal associates and external physicians.
  • Participate in care management and grievance processes.
  • Collaborate with team members and other departments.

What they look for

  • MD or DO degree with Board Certification.
  • 5+ years of clinical patient care experience.
  • Current and unrestricted medical license.
  • Experience in Medicare or inpatient care.
  • Strong verbal and written communication skills.

Nice to have

  • Understanding of coding practices and clinical documentation.

Benefits

  • Health benefits and professional development opportunities.

How Keywordise applies for you

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Message for Muse
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Questions about this job

Can I do this job remotely, and from which countries?

Yes, it is listed as remote, and the posting does not tie it to one country.

What does this job pay?

No pay range is stated in the posting.

What experience is needed?

It is a lead role. The posting asks for: MD or DO degree with Board Certification; 5+ years of clinical patient care experience; current and unrestricted medical license. Skills it names include Medicare, Care management.

How do I apply with Keywordise AI?

Select Apply with Keywordise AI, sign up and upload your CV. Keywordise writes a CV and a cover letter for this job from your real experience and applies for you. The 7-day free trial needs no card.

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