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National Clinical Director

2 weeks ago


Torrance, California, United States Humana Inc. Full time

As a key member of Humana Inc.

National Clinical Director

HQRI is seeking a talented physician executive to contribute to national planning and operations for Risk Adjustment, Stars, and Interoperability.

This role will carry individual contributor and leadership responsibilities across these areas.

We are looking for someone with excellent communication skills, both written and verbal, and 5 years of established clinical experience.

A current and unrestricted license in at least one jurisdiction is required, as well as Board Certification in an approved ABMS Medical Specialty.

The ideal candidate will have knowledge of the managed care industry, including Medicare, Medicaid and/or Commercial products.

Key Responsibilities:

  1. Inform and support HQRI's provider strategy across Stars, RA, and Interoperability.
  2. Serve as a coding expert to manage escalations or establish compliant policies.
  3. Contribute as a clinical industry representative.
  4. Lead HQRI's Provider Support team (PST) that drives national provider education strategy and operations.
  5. Support corporate and regional strategies for physician and healthcare provider education or operations for Risk Adjustment and Stars.
  6. Provide clinical and coding expertise across the teams in HQRI.
  7. Support interoperability efforts.

This position reports to the Vice President of Strategy Advancement in the Healthcare Quality Reporting and Improvement organization (HQRI).