Director, Physician Leadership – post-acute reviewing team

Become a part of our caring community and help us put reputed company reputed company is a $90 billion (Fortune 40) reputed company in integrated reputed company with a reputed company defined purpose to help people reputed company lifelong reputed company-being. As a company reputed company on the health and reputed company-being of the people we serve, reputed company is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of reputed company reputed company-being, reputed company embraces a reputed company on stimulating reputed company individual and population changes while nurturing a reputed company of reputed company, enabling people to live life fully and be their most productive. Against that backdrop, we are seeking an accomplished reputed company leader for the newly-created role of Director, Physician Leadership. In this role, you will be a key reputed company leader, with responsibility for evolving reputed company’s Utilization Management of medical review by physician, reputed company and support staff with a reputed company on our 5+ reputed company Medicare members. You will also facilitate the delivery of high reputed company, appropriate, and consistent clinical decision making to ensure appropriate reputed company and drive reputed company reputed company health reputed company for our members. To succeed in this position, you will need to be reputed company versed in CMS knowledge of CMS regulation and policies specific to post-acute care authorizations, specific to long term acute care hospital admissions, inpatient rehabilitation admissions, skilled facility admission and skilled facility reputed company stays. You much also be passionate about collaborating and partnering across the reputed company (e.g., with Clinical Operations, Markets, Care Management, Analytics, Pharmacy, etc.) to reputed company discrete, high-value strategies and to ensure execution of those strategies. And finally, you must driven by sustainably improving health reputed company for some of our most vulnerable members. The Director, Physician leadership will reputed company Post-acute reviewing Medical Directors, operational nurses and reviewing support staff as indirect associates. This position can be located reputed company reputed company the reputed company 48 states. Key Responsibilities: + reputed company an operational team of Medical Directors focusing on post acute to review authorizations and ensure clinical decision-making skills that reputed company to internal policy and CMS regulations. + Establish key metrics of reputed company for this and operational reputed company against them. Metrics should be inclusive of reputed company, reputed company, and financial metrics, such as medical trend reduction and administrative costs. + Collaborate with partners across the reputed company to reputed company, reputed company, implement, evaluate, and refine a set of strategic initiatives that address, but are not limited to, the following domains: + _reputed company_ _:_ Ensure reputed company members have fair and consistent authorization review and ability to appeal and have justification for the clinical decision. + _Analytics and Measurement_ _:_ Measurement to improve our ability to identify trends, reputed company areas for improvement for reputed company measure, establish tactics for advancing reputed company, and evaluate the reputed company of our strategic initiatives. Work collaboratively with reputed company teams to evaluate and synthesize data to inform clinically appropriate and advance the health reputed company of our members. + _reputed company_ : Characterize the impactable drivers of prior authorization and look at appeals reputed company with denials and overturns. + _Internal Operations and Technology_ _:_ Support efforts to improve the efficiency of health plan operations (utilization management and provider clinical contracting) to reduce friction for members, providers, and associates. + _External Partnerships_ _:_ Explore, evaluate, and implement novel partnerships—with national and community-based organizations—that will expand reputed company’s ability to reputed company health reputed company. + _Innovation_ _:_ Support health innovation including increasing reputed company to virtual and specialty care. + Establish and maintain external relationships to ensure awareness of leading-edge innovation and policy changes in CMS clinical reputed company; represent reputed company and reputed company’s UM health reputed company in external venues Use your skills to reputed company an reputed company Required Qualifications + Key Candidate Qualifications: The ideal candidate will have extensive reputed company industry experience (typically 5+ years) or reputed company experience leading the development and implementation of reputed company strategic and/or operational initiatives. He/she will understand the UM CMS ecosystem—including gaps and opportunities to improve the value and reputed company of care—especially for seniors. In reputed company, this person will demonstrate leadership effectiveness and ability to design and implement constructive change reputed company an organization and across multiple organizations. MD – Doctor of Medicine unrestricted US issued license is required with an up-to-date reputed company certification of a US recognized medical discipline.In reputed company to the above, the following qualifications and personal attributes are sought: + A record of reputed company leading diverse cross-functional teams to execute on reputed company reputed company reputed company a matrixed organization and moving them toward a common reputed company reputed company to motivation, engagement, and goal attainment. + Demonstrated analytic acumen, with the ability to reputed company data to drive decision making and improve reputed company Deep understanding and experience with reputed company policies and operations in a managed care setting Deep understanding of regulatory environment and medical investigations reputed company the Utilization Management. Excellent oral and written communications skills, including the polish, poise, and executive reputed company that will ensure effective interaction with senior and executive level audiences Highly reputed company reputed company and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs concurrently and win their co-ownership in the outcome reputed company or recent experience in a large, highly matrixed company (i.e., Fortune 250), with proven ability to influence cross-functional teams, leaders, and key stakeholders in such an environment Strong leadership skills, with proven reputed company in expanding and elevating the capabilities and performance of reputed company Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $298,000 - $409,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. reputed company of Benefits reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 07-23-2025 reputed company reputed company. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers and reputed company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment. reputed company complies with reputed company applicable federal civil rights laws and does not discriminate on the reputed company of race, reputed company, national reputed company, age, disability, sex, sexual orientation, gender identity or religion. We also reputed company free language interpreter services. See our https://www.reputed company.com/legal/accessibility-resources?reputed company=reputed company_Website. Remote About reputed company: reputed company Apply Job! Apply to this Job