Humana

Lead Medical Director - OneHome

San Antonio, Texas, United States

Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Managed CareIndustries

Requirements

Candidates must possess an MD or DO degree and hold current, ongoing board certification in an approved ABMS Medical Specialty. A current and unrestricted medical license in at least one jurisdiction is required, with willingness to obtain additional licenses as needed. The role demands over 5 years of direct clinical patient care experience post-residency or fellowship, no current sanctions from governmental organizations, and the ability to pass credentialing requirements. Strong analytical and interpretive skills, along with knowledge of national guidelines such as NCD/LCD, MCG®, or InterQual, are essential. Preferred qualifications include demonstrated experience in operations and performance management, experience in an inpatient environment or with Medicare populations, and two or more years of management experience. A commitment to innovation, diversity, equity, and inclusion is also preferred.

Responsibilities

The Lead Medical Director will manage the physician review of health requests across various OneHome businesses, providing medical interpretation and decisions on the appropriateness of services. This role involves identifying and resolving complex technical and operational problems, potentially leading multiple managers or specialized associates. Responsibilities include maintaining the medical director schedule, developing collaborative relationships with key partners, managing regular meetings, and fostering the development of other medical directors. The Lead Medical Director may also lead specific functional areas within the department.

Skills

Medical Directing
Clinical Patient Care
Quality Management
Utilization Management
Case Management
National Guidelines (NCD/LCD, MCG, InterQual)
Medical Interpretation
Problem-Solving
Communication Skills
Analytical Skills
Interpretive Skills

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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