Commercial Medical Director Team Lead

DescriptionRole: HCO Commercial Medical Director Team LeadAssignment: HealthCare Operations- Oversight of Commercial Physician Review teamLocation: All Markets - Work From HomeGeneral DescriptionThe Commercial Physician Review Medical Director Team Leads will hire, lead and develop a team of commercial physician reviewers. They will manage and coach team members to ensure that timely and accurate clinical determinations are made. They will serve as a resource for internal Humana departments as well as external partners. The team lead will encourage associate engagement and talent growth. They will develop strategy, work with enterprise partners and drive quality trend results. The Lead Medical role would require a collaborative and forward thinking candidate.ResponsibilitiesJob Responsibilities

Overseeing training and onboarding of new medical directors for the national commercial physician review team reviewing inpatient, outpatient, pharmacy and appeals reviews.

Provide daily guidance to and oversight of assigned Medical Directors

Monitor initial and appeal review processes, including but not limited to daily case volume and workflow, compliance, opportunities for improvements, and consistency/accuracy of decisions

Act as a clinical resource for team members on all case types

Assist in mentoring and training new associates

Provide guidance, assistance and mentoring for escalated cases

Coordinate week/weekend scheduling, including paid time off, CME, and holidays to ensure adequate coverage for review process

Assist in development, implementation and ongoing performance of quality review process

Participate in or lead operational meetings with areas of interface across the organization

Participate in and provide clinicial consultation to other Humana departments as needed

Lead team meetings and case conferences

Define and monitor adherence to team productivity and quality goals

Role Essentials

MD or DO

Board Certified in an approved ABMS Medical Specialty with continued certification throughout employment

Active unrestricted license

Ability to be licensed in multiple states without restrictions

5 or more years of clinical experience

3 or more years commercial health plan utilization management experience

2 or more years of current & ongoing management oversight of employees/associates

Ability to collaborate with and lead a team

Demonstrated experience in conflict resolution, mentoring/coaching, and assisting with career advancement

Proficiency with computer and programs (Word/Excel/PowerPoint)

Excellent presentation and analytical skills

Effective communication skills, written and oral

Experience with analytic tools and utilization data

Experience with training and teaching others

Role Desirables

Master’s degree: MBA, MPH, MHA, or equivalent preferred

Reporting RelationshipsYou will report to the Associate Vice President of Market/Industry Insights, CPS. This area is under the leadership of the Senior Vice President, Chief Medical Officer, CPS.Humana ValuesInspire healthWe inspire health by making conscious choices every day and motivating others with our positive example. We care about each other and actively contribute to an environment of well- being.Cultivate uniquenessWe find ways to connect with each other and our consumers. Respecting one another, listening with an open mind, and seeking different perspectives result in richer solutions.Rethink routineInnovation emerges from a culture that cultivates curiosity. We spark creativity by challenging ourselves to think differently.Pioneer simplicityWe make life easier and believe that less can be more. When we empower associates with responsibility, we are able to create anagile organization and an exceptional experience.Thrive togetherWe make life easier and believe that less can be more. When we empower associates with responsibility, we are able to create an agile organization and an exceptional experience.#physiciancareersScheduled Weekly Hours40About UsMission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity EmployerIt is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailboxtasrecruit@humana.com for assistance.Humana Safety and SecurityHumana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailboxtasrecruit@humana.com to validate the request.California ResidentsIf you are a California resident and would like to review our California Consumer Privacy Act (CCPA) Policy click here:CA Resident Privacy Policy