Become a part of our caring community and help us put health first
 

Humana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana 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, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, 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 Humana’s Utilization Management of medical review by physician or nurse, 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 better quality health outcomes for our members.

To succeed in this position, you will need to be well versed in CMS knowledge of outpatient, inpatient, behavioral health and appeal criteria including regulation and policies. You much also be passionate about collaborating and partnering across the enterprise (e.g., with Clinical Operations, Markets, Care Management, Analytics, Pharmacy, etc.) to develop 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 lead Medical Directors performing utilization management for Medicare inpatient and behavioral medicine case types. This position can be located anywhere within the lower 48 states. 

Key Responsibilities:

• Lead an operational team of Medical Directors 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 progress 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 develop, articulate, implement, evaluate, and refine a set of strategic initiatives that address, but are not limited to, the following domains:
  • Access: Ensure Humana 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, highlight 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 Success in driving consistent and quality outcomes for our members.
• 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 Humana’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 Humana and Humana’s UM health strategy in external venues

Use your skills to make an impact
 

Required Qualifications

• The ideal candidate will have extensive healthcare industry experience (typically 5+ years) or related experience leading the development and implementation of complex 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 within an organization and across multiple organizations.  Medical Doctorate Degree with unrestricted up to date certification and up to date board certification in 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 complex projects within a matrixed organization and moving them toward a common vision related to motivation, engagement, and goal attainment.
• Demonstrated analytic acumen, with the ability to leverage data to drive decision making and improve outcomes
• Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences
• Highly collaborative mindset and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs concurrently and win their co-ownership in the outcome 
• Current 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 
• Deep understanding and experience with healthcare policies and operations in a managed care setting
• Deep understanding of regulatory environment and medical investigations within the utilization management and behavior health utilization management.

Preferred Qualifications

• Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
• Internal Medicine, Family Practice, Geriatrics, OBGYN, Hospitalist clinical specialists.

Additional Information

Travel: While this is a remote position, occasional travel to Humana'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 base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related 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

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) 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 outside of work. Among our benefits, Humana 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
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana 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 base all employment decisions only on valid job requirements. This policy shall apply to all 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 all levels of employment.