National Physician Leader, OneHome Expansion

Humana

Olympia, WA(remote)

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JOB DETAILS

SALARY

$298,000–$409,800 Per Year

SKILLS

Acute Care, Affirmative Action, Business Administration, Centers for Medicare and Medicaid Services (CMS), Clinical Outcomes, Clinical Support, Coaching, Content Management Systems (CMS), Continuous Improvement, Cross-Functional, Customer Escalations, Customer Experience, Delivery Driving, Durable Medical Equipment, Genetics, Health Plan, Healthcare, Healthcare Providers, Home Care, Hospital, Insurance, Leadership, Maintain Compliance, Medicaid, Medicare, Medicine, Mentoring, Military, Performance Management, Process Improvement, Quality Management, Regulations, Rehabilitation Act, Requirements Validation/Verification, Strategic Planning, System Integration (SI), Team Building, Team Lead/Manager, Utilization Management, Willing to Travel

LOCATION

Olympia, WA

POSTED

30+ days ago

**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: Clinical decision-making (case review & UM oversight) Team leadership 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 at?Humana.com?and at?CenterWell.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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

About the Company

Humana

INDUSTRY

Other/Not Classified