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UF Health physicians offer primary care and specialty services in practices throughout Northeast Florida and Southeast Georgia, tallying more than 650,000 outpatient visits and more than 40,000 inpatient admissions annually.
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The clinical scenarios predominantly arise from inpatient or post-acute care environments. 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 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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Medical Director - Southeast Region. Become a part of our caring community and help us put health first. 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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Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. May also engage in grievance and appeals reviews.
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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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Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialization.
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Advanced degree such as an MBA, MHA, or MPH. Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business.
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At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Experience with national guidelines such as MCG or InterQual.
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Exposure to Public Health principles, Population Health, analytics, and use of business metrics. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work.
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Satellite, cellular and microwave connection can be used only if approved by leadership. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
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The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources.
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Supports the assigned work with respect to market-wide objectives (e.g. Bold Goal) and community relations as directed. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type.
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Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. 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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southeast inpatient jobs Company: Emory University
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