[Remote] Associate Director, Medicare Clinical Coverage Policies at Humana

Kentucky, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Bachelor's Degree
6 or more years of technical experience
3 or more years of leadership experience with direct reports
2 or more years of compliance or policy writing experience
Strategic thinking and planning capabilities; organized and detail-oriented
Excellent written and verbal communication skills
Experience and understanding of Medicare managed care

Responsibilities

Work closely with physicians, nurses, G&A, UMC, vendors, risk, and compliance to ensure all Medicare clinical coverage policies are meeting the needs of the users and that they are compliant
Deliver clinical insight and information to both internal and external customers in order to ensure compliance of the Medicare clinical coverage policies
Meet regularly with customers, brokers, physicians, and other providers to address clinical issues and strategies
Serve as key internal clinical resource for multiple departments, especially clinical management and utilization groups
Leverage clinical experience and deep knowledge of managed care to find the best solutions for all customers
Liaise with external thought leaders, professional societies, and other community-based organizations focused on improving health status

Skills

Medicare

Clinical Coverage Policies

Compliance

Policy Writing

Strategic Thinking

Communication

Relationship Management

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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