Role: Provider Network Medical Director Assignment: National Network Organization
Clinical: Make a difference in people’s lives
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.
Be a part of our Provider Network team that’s dedicated to improving the health and well-being of our members, our associates, and the communities we serve. This position offers an exciting opportunity to provide clinical leadership in Humana’s National Network Operations group influencing three key areas: Provider Relations, Clinical Outcomes, and Medical Cost Trend.
Serve as the clinical leader and key interface/contact with all value-based provider groups in the region
Consult with and interface closely with the Office of the Chief Medical Officer (OCMO) and other corporate clinical resources, collaboratively representing market specific input and Provider Development strategies, while also incorporating guidance from and ensuring alignment with OCMO initiatives
Play a lead role, nationally and within the region, regarding Care Insights and other physician-focused related initiatives and tools. Work directly with market-based PCPs and Specialist in terms of helping them to improve both their efficiency and effectiveness, explaining the analysis and offering insights
Serve as the main market-based regional point of contact for value-based provider groups regarding Care Insights, meeting face-to-face and “Dr. to Dr." to explain, educate, promote and roll out Care Insights and related physician-focused initiatives
Interfacing with the National Contracting team, as well as other areas of Provider Development (PDCoE, Strategy & Analytics, Transcend, Alliances, PPS), provide internal consulting-based clinical guidance to enhance strategy & improve outcomes.
Leads Positively: Leads by example to cultivate a climate of motivation, positive energy and meaning in work. Assesses, selects, recognizes, develops, and empowers diverse talent.
Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.
Acts Strategically: Makes decisions and sets strategy based on the long-term vision, uses an enterprise-wide perspective to translate strategies into actions, inspires others to embrace and advance the strategy, and creates a clear view of the future state.
Leads Change: Guides and energizes others, models adaptability, and inspires strong organizational performance through periods of transformation, ambiguity, and complexity.
Board Certified with an ABMS approved specialty.
Active, unrestricted State License.
Minimum of 5 years medical management leadership experience.
Effective influencing without formal authority: working through others for personal and organizational success.
Ability to manage multiple projects and priorities effectively and to accept direction according to the market needs and priorities.
Excellent presentation and analytical skills.
Exceptional written and oral communication skills to a wide range of both internal and external audiences.
Ability to rapidly build positive relationships with providers at all levels in the marketplace
Prior experience in Health Plan operations, provider education, or provider networking
Master’s Degree in Business Administration or a related field
Internal Number: 187070
Humana Inc. (NYSE: HUM) is focused on improving the health of the communities we serve by making it
easy for people to achieve their best health through clinical excellence and coordinated care.
Our diverse lines of business work to serve all types of consumers. From families to seniors to military members to self-employed individuals, there is a plan to meet many unique needs. Humana's associates and corporate leaders are committed to customer service. Our team uses innovation to deliver results to our consumers.