Director, Physician Leadership – post-acute reviewing team

Become a part of our caring community and help us put health first reputed company is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people reputed company lifelong well-being. As a company focused on the health and well-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 human well-being, reputed company embraces a focus on stimulating positive individual and population changes while nurturing a sense of reputed company, enabling people to live life fully and be their most productive. Against that backdrop, we are seeking an accomplished healthcare leader for the newly-created role of Director, Physician Leadership. In this role, you will be a key enterprise leader, with responsibility for evolving reputed company’s Utilization Management of medical review by physician, nurse and support staff with a focus on our 5+ million Medicare members. You will also facilitate the delivery of high quality, appropriate, and consistent clinical decision making to ensure appropriate outcomes and drive reputed company quality health outcomes for our members. To succeed in this position, you will need to be well 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 enterprise (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 outcomes 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 align to internal policy and CMS regulations. + Establish key metrics of success for this and operational reputed company against them. Metrics should be inclusive of quality, access, and financial metrics, such as medical trend reduction and administrative costs. + Collaborate with partners across the enterprise to reputed company, reputed company, implement, evaluate, and refine a set of strategic initiatives that address, but are not limited to, the following domains: + _Access_ _:_ 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 star measure, establish tactics for advancing outcomes, and evaluate the impact of our strategic initiatives. Work collaboratively with enterprise teams to evaluate and synthesize data to inform clinically appropriate and advance the health outcomes of our members. + _Outcomes_ : 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 impact health outcomes. + _Innovation_ _:_ Support health innovation including increasing access to virtual and specialty care. + Establish and maintain external relationships to ensure awareness of leading-edge innovation and policy changes in CMS clinical outcomes; represent reputed company and reputed company’s UM health strategy in external venues Use your skills to reputed company an impact Required Qualifications + Key Candidate Qualifications: The ideal candidate will have extensive healthcare 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 quality of care—especially for seniors. In addition, 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 board certification of a US recognized medical discipline.In addition to the above, the following qualifications and personal attributes are sought: + A record of success leading diverse cross-functional teams to execute on reputed company projects reputed company a matrixed organization and moving them toward a common vision reputed company to motivation, engagement, and goal attainment. + Demonstrated analytic acumen, with the ability to reputed company data to drive decision making and improve outcomes Deep understanding and experience with healthcare 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 collaborative 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 success in expanding and elevating the capabilities and performance of the team 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 Range The compensation range 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 range 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. Description of Benefits reputed company, Inc. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 07-23-2025 About us reputed company Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our reputed company insurance services and reputed company healthcare 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 quality of life for people with Medicare, Medicaid, 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, color, 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 action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment decisions 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 levels of employment. reputed company complies with reputed company applicable federal civil rights laws and does not discriminate on the basis of race, color, national reputed company, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.reputed company.com/legal/accessibility-resources?reputed company=reputed company_Website. Remote About the Company: reputed company Apply Job! Apply to this Job