Job Description:
Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.

Role: Clinical Innovations / Clinical Advisor, MD
Location: Columbus, Ohio
Are you a fit?
Do you enjoy defining clinical strategy for a major market area? Do you have a desire to be in a position where you can 'provide guidance to our members related to their health care needs?

Putting the "Guide" in Guidance.

When it comes to our members, guidance matters. The important work of our Medical Directors directly impacts our members, sometimes during the most vulnerable moments of their lives. Whether evaluating new technology, devices, pharmaceuticals or healthcare providers, it is the passion and commitment of the Humana medical director team enabling Humana's vision of becoming the most trusted name in healthcare solutions.

Humana is looking for a high-energy physician with solid clinical experience, a passion for evidenced-based medicine, who enjoys innovation. This Medical Director role begins with a primary focus on on Utilization Management and Special Investigations for Medicare products.

This role carries with it important leadership opportunities within the company. You will participate in Humana Market meetings, lending your expertise, experience and leadership as it relates to important decisions affecting the business. You will be instrumental in driving how we develop and manage programs, centered on continuously evaluating and improving our clinical model and how we participate in the delivery of health benefits solutions.

Medical Director key contributions:
-Using your clinical expertise to manage the clinical model, providing medical interpretation and decisions as required.
-Participating in committees (e.g. quality, credentialing, pharmacy and therapeutics, technology assessment, etc.) which require medical expertise and are required either by regulation, accreditation and/or local market conditions.
-Interfacing with other clinical leadership which includes our staff of Regional Medical Directors and market-based physicians.

Assignment Capsule
You will collaborate with other health care givers in reviewing actual and proposed medical care and services against established DOI guidelines.

• Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design.
  
• Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally.
  
• Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols.
  
• Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria.
  
• Conduct admission review, post-discharge calls and discharge planning.

• Leveraging Technology: You are technological savvy and know how to appropriately share and use your knowledge to improve business results.
  
• Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
  
• Is Accountable: You meet clearly stated expectations and take responsibility for achieving results.
  
• Clinical Knowledge: You understand clinical program design, implementation, management/monitoring to support choice in consumer medical care. Understands the medical utilization implications of such programs
  
• Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.

• A current and unrestricted Physician License in at least one jurisdiction and willin
  
  Expected Travel Time: About 50%