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About Us About onehome: onehome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. onehome was acquired by Humana in 2021 to advance value-based care.
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The clinical scenarios predominantly arise from inpatient or post-acute care environments. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management.
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Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it.
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About onehome: onehome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company.
$57,700 - $79,500 a yearInternExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation.
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5+ years of established clinical, direct patient care experience post residency or fellowship. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it.
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5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age.
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Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
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The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. The Medical Director provides 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.
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Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion.
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Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management.
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Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. Medical Directors support Humana values, and Humana's Bold Goal mission, throughout all activities.
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Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized.
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