Humana Central Region Medical Director - AR, OK OR WAH in Kansas City, Kansas

Role: Medical Director

Assignment:Senior Product Market

*Location: *OK, AR or WAH

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.

Assignment Capsule

Be a part of our Clinical Operations team that’s dedicated to improving the health and well-being of our members, our associates, the communities we serve, and our planet.

Humana is seeking a 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. This position will be responsible for the a region consisting of OK, AR, MO, and KS.

  • 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

Role Essentials

  • 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.

Role Desirables

  • Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
  • Internal Medicine, Family Practice, Geriatrics, Hospitalist clinical specialists.
  • Previous Medicare, Medicaid, and/or Commercial experience.

Reporting Relationships

You will report to a Regional Medical Director. This area is under the leadership of the SVP & Division President.

Additional Information

At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.

After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what’s happening around our organization in the changing world of healthcare.

Title: Central Region Medical Director - AR, OK OR WAH

Location: Oklahoma-Tulsa

Other Locations: US-AR-Little Rock AFB, US-Kansas-Kansas City, US-Missouri

Requisition ID: 191605

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.