Description

Become a part of our caring community
The National Physician Leader relies on medical background and reviews health claims, requiring a solid understanding of how organization capabilities interrelate across department(s).
You will provide clinical leadership across home health and post-acute utilization management, while also driving strategic initiatives that improve quality, access, and cost of care.

This role blends:
\t Clinical decision-making (case review & UM oversight)
\t Team leadership
\t Enterprise influence and strategy execution

Lead the Future of Care Delivered at Home

At OneHome, we are transforming how care is delivered beyond the hospital bringing together home health, DME, infusion, and community-based care into one integrated experience.

As part of Humana, a national leader in value-based care, this role offers a unique opportunity to operate at the intersection of payer, provider, and home-based care delivery where clinical leadership directly shapes outcomes, cost, and experience at scale.

What Makes This Role Different
1. Influence Care at Scale

• Impact care decisions for millions of Medicare Advantage members
• Shape how care is delivered across the entire post-acute continuum, not just one silo
• Operate in a payer-provider integrated model-a key advantage vs. traditional UM-only roles

2. Practice High-Impact, Modern Medicine

• Move beyond transactional reviews into strategic, outcomes-driven clinical leadership
• Lead initiatives in:
  
  • Hospital avoidance & SNF diversion
  • Home-based alternatives (Hospital at Home, advanced home care models)
  • Value-based partnerships

3. Lead in a Culture Built on Humanity & Performance
Your leadership is guided by The Humana Way-a culture system designed to create simpler, faster, better healthcare

You will lead by:

• Listening first (member + provider centricity)
• Simplifying complexity (removing friction from care delivery)
• Driving bold outcomes (not activity)
• Anticipating future needs (vs reacting)
• Building one team across silos

4. Competitive Rewards & Flexibility

• Highly competitive executive-level compensation + bonus
• Remote flexibility with national scope
• Strong clinical leadership career path within Humana/OneHome
• Opportunity to shape strategy-not just execute it

Key Responsibilities

Clinical Leadership & Medical Decision-Making

• Review and oversee post-acute medical director team for home health, SNF, DME and potentially others in time.
• Lead, mentor, and support teams of clinical associates, managers, and specialized professionals within the department.
• Ensure clinical appropriateness using CMS, Medicare Advantage, and evidence-based guidelines
• Lead resolution of complex or escalated cases
• Maintain ~50% involvement in direct clinical review work

Post-Acute Strategy & Innovation

• Advance site-of-care optimization (home vs. facility-based care)
• Partner with internal teams to design and scale home-based care models
• Contribute to strategy for integrated post-acute networks and partnerships

Quality & Performance Improvement

• Drive improvements in:
• Readmissions and avoidable utilization
• HH episode/visit efficiency and SNF length of stay
• Member experience and care access
• Use analytics to identify variation and implement targeted interventions

Team Leadership & Development

• Lead and coach Medical Directors and clinical professionals
• Build a culture of accountability, collaboration, and continuous improvement
• Align team performance to enterprise goals and outcomes

Operational Excellence

• Improve utilization management workflows, turnaround times, and consistency
• Ensure regulatory compliance and audit readiness
• Optimize staffing models and clinical resource deployment

Cross-Functional Collaboration

• Care management
• Provider/network teams
• Clinical program leaders
• Operations and compliance
• Act as a key clinical voice across OneHome and Humana

Sponsorship is not available for this role

Use your skills to make an impact

Qualifications

Required

• MD or DO with unrestricted U.S. license
• Board certification (ABMS)
• 3+ years in Medicare Advantage, utilization management, or post-acute care
• Experience in clinical decision-making within health plans or integrated systems
• Strong knowledge of CMS regulations and UM principles
• Proven leadership in matrixed or cross-functional environments
• Data-driven mindset with ability to translate insights into action

Preferred

• Experience in home health, post-acute, or value-based care models
• Leader of multi-market or distributed clinical teams
• MBA, MMM, or advanced leadership training
• Background in payer-provider integrated organizations

Success in This Role

You will know you are succeeding when:

• Members experience seamless, high-quality care at home
• Providers view you as a trusted clinical partner-not a barrier
• Teams are engaged, accountable, and aligned
• Clinical decisions consistently balance quality, experience, and cost
• You are influencing not just cases-but the future of care delivery

Why OneHome + Humana

OneHome is redefining post-acute care as part of Humana's bold vision to put health first. Together, we are:

• Scaling home-centered care models nationally
• Leading the shift to value-based, outcomes-driven healthcare
• Building a system that is simpler, more human, and more effective

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: 10-27-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

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.
Requisition #: R-417817

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