Commercial Medical Director(KEHP): Work-At-Home
Humana - Louisville, KY

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You will collaborate with other health care givers in reviewing actual and proposed medical care and services against established DOI guidelines.
  • Provides support and guidance for appeals, medication prior-authorization requests, and benefit designs and levels
  • Develop, maintain and assure compliance with physician review policies and procedures (including timeliness) for utilization management and support case management
  • Conduct admission review, post-discharge and discharge planning with clinical staff and peers
  • Onsite rounding with clinical staff to support utilization and case management
Key Competencies
  • Leveraging Technology: You are technological savvy and know how to appropriately share and use your knowledge to improve business results.
  • Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
  • Is Accountable: You meet clearly stated expectations and take responsibility for achieving results.
  • Clinical Knowledge: You understand clinical program design, implementation, management/monitoring to support choice in consumer medical care. Understands the medical utilization implications of such programs
  • Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.

Qualifications
Role Essentials
  • A current and unrestricted license in KY, and willing to obtain license, as required, for various states in region of assignment
  • MD or DO degree
  • Board Certified in an approved ABMS Medical Specialty
  • 5+ years clinical practice experience with strong knowledge of the managed care industry
  • Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
  • Process-oriented, evidence-based and scientifically-inclined, consistent, enjoys being a part of a team, thoughtful and has a thirst for continuous education and development.
  • Excellent telephonic communication skills; excellent interpersonal communication skills
Role Desirables
  • Experience in community based and chronic disease management
  • Board Certification in Internal Medicine or Family Medicine
  • Proficiency in working in a matrix environment
  • Previous experience leading teams focusing on utilization management, discharge planning and/or home health or rehab

Schedule : Full-time

Primary Location : US-KY-Louisville

Role : Clinical Innovations and Health Practitioners

Work Environment Type : Virtual/Work At Home

Travel : Yes, 5 % of the Time

Humana - 22 months ago - save job
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Humana Inc. (Humana) is a full-service benefits solutions company, offering an array of health and supplemental benefit plans for employer...