Humana Regional Medical Director - Mid-Atlantic in Delaware

Role: *Mid-Atlantic Regional Medical Director Assignment: Senior Segment
Richmond, VA, OR Charlotte/Raleigh, NC

Are you a fit? Do you enjoy defining clinical strategy for a major market area? Do you have a desire to be in a position where you can provide guidance to our members and our physician partners related to their health care needs? Does this sound like you? If so, then read on!

Assignment Capsule

As a Regional Medical Director you will have responsibility for Medicare business in the Mid-Atlantic region in addition to the following responsibilities:

  • Provide oversight and direction for the implementation of regional clinical programs and strategies, as well as, developing and implementing market level strategies.
  • Support the Network Management team in both contract development and on-going delegated risk group clinical assessment efforts.
  • Coordinate efforts, decisions and resources with other Humana Medical Directors as necessary (e.g. RX, Med Necessity, Transplant, COE, etc).
  • Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTACH, Acute rehab, SNF) according to the Humana Medicare Model of Care (MMOC) in all cases where Humana retains some or all of Part A risk in the contractual relationship with IPA’s/MG’s. Also use MMOC to manage HMO & POS members who utilize their out-of-network benefits.
  • Participation in Quality Operations Committee, complete initial peer review on quality of care complaints, complete peer-to-peer written and verbal communications.
  • Participate in regional level committees and meetings setting medical necessity strategies.
  • Manage internal operational/functional relationships related to profitability.
  • Clinical liaisons with inpatient facilities to maintain relationship and problem solve; especially reviewing contracts as to clinical services.
  • Problem solving via joint operating committee’s & internal operational meetings

    Role Essentials
    o Board Certified MD/DO in an ABMS Medical Specialty

    o Active, unrestricted license

    o Experience in community based and chronic disease management

    o 5 years clinical practice experience with strong knowledge of the managed care industry

    o Medicare/Medicaid Knowledge

    o Supervisory skills including clinical mentoring and coaching

    o Excellent presentation and analytical skills

    o Exceptional written and oral communication skills to a wide range of associates (front-line to leaders) and both internal and external audiences.

    o Visibility and involvement in medical community

    o Ability to rapidly build positive relationships with consumers, employers, and providers at all levels in the marketplace

    o Travel between 30-50% dependent on location of residence

    o Incumbent must be located in the region of the territory. /Preference is in Richmond, VA but will consider/ /Charlotte/Raleigh, NC, DC, MD, and DE understanding regular travel to Richmond, VA is required/.

    Role Desirables

    o Master’s Degree in Business Administration or a related field

    o Board Certified in Internal Medicine, Family Medicine, or Geriatrics

    o Ability to thrive in a highly matrix environment

Title: Regional Medical Director - Mid-Atlantic

Location: Virginia-Glen Allen

Other Locations: US-North Carolina-Charlotte, US-Virginia-Glen Allen, US-North Carolina-Raleigh, US-DC-Washington, US-Delaware, US-Virginia, US-Maryland

Requisition ID: 179016

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.