[Remote] Medical Director - OneHome at Humana

San Antonio, Texas, United States

Apply Now

Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

MD or DO degree
Current and ongoing board certification in an approved ABMS Medical Specialty
Current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment
5+ years of direct clinical patient care experience post residency or fellowship
No sanctions from Federal or State Governmental organizations
Ability to pass credentialing requirements
Excellent verbal and written communication skills with analytic and interpretative skills
Participation in educational activities by attending required conferences
Ability to create content to lead/teach/present for individual subject matter contribution

Responsibilities

Provide medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts
Provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards
Conduct clinical case reviews of requests received by members of the Medicare population and report to the Lead Medical Director
Identify medical management operational improvements, including those within the medical director area
Participate in call rotation which may include weekend coverage
Develop collaborative relationships with Team and key partners within the Medicare Line of Business
Support Home Solutions as needed
Perform other activities as assigned by the managing Medical Director
Travel to Humana's offices for training or meetings as required

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.

Land your dream remote job 3x faster with AI

Try Jobo Free