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Director of Clinical Management

2 weeks ago


Nashville, Tennessee, United States Humana Full time
About the Role

We are seeking a highly skilled Medical Director to join our team at Humana. As a key member of our clinical management team, you will be responsible for overseeing the delivery of patient care services, ensuring that they meet the highest standards of quality and regulatory compliance.

Key Responsibilities:

  • Developing and implementing clinical management strategies to improve patient outcomes and reduce costs
  • Collaborating with internal teams to achieve operational efficiency and effectiveness
  • Maintaining up-to-date knowledge of national guidelines, CMS policies, and Humana procedures
  • Providing medical interpretation and determinations in accordance with established standards
  • Supporting Humana's Bold Goal mission through daily activities

Requirements:

  1. MD or DO degree from an accredited institution
  2. At least 5 years of direct clinical patient care experience post-residency or fellowship, preferably in an inpatient environment
  3. Board Certification in an approved ABMS Medical Specialty
  4. A current and unrestricted license in at least one jurisdiction
  5. No current sanctions from Federal or State Governmental organizations
  6. Excellent verbal and written communication skills
  7. Evidence of analytic and interpretation skills, with prior experience in quality management, utilization management, case management, discharge planning, and/or home health or post-acute services