Humana is seeking a Clinical Innovations Medical Director that will collaborate with other health care givers in reviewing actual and proposed medical care services against established CMS, DOI, Humana and other nationally recognized and accepted guidelines.
Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.
Positions are available nationwide and are Work-at-Home.
Provide physician review services for utilization management, case management, quality management, and conduct peer to peer reviews
Develop, maintain and assure compliance with physician review policies and procedures (including timeliness) for utilization management and support case management
Support collaborative relationships with physicians, large provider groups, hospitals, other facilities and ancillary providers
Examine clinical programs information to identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria
Conduct admission review, post-discharge and discharge planning with clinical staff and peers
Board Certified MD/DO in a ABMS Medical Specialty with an active unrestricted license and the willingness to obtain additional licenses as requested;
Excellent communication skills, with 5 years of established clinical experience.
Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products.
Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab.
Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc
Internal Medicine, Family Practice, Geriatrics, Hospitalist clinical specialists
Humana Inc. (NYSE: HUM) is focused on improving the health of the communities we serve by making it
easy for people to achieve their best health through clinical excellence and coordinated care.
Our diverse lines of business work to serve all types of consumers. From families to seniors to military members to self-employed individuals, there is a plan to meet many unique needs. Humana's associates and corporate leaders are committed to customer service. Our team uses innovation to deliver results to our consumers.