HumanaNewVP, Physician Review and Market Insights HumanaVP, Physician Review and Market InsightsOlympia, WARemoteDirect reports include:** **VP, Physician Leadership** **Clinical contracting, physician review, quality improvement, legal MDs** **Director, Physician Leadership** **MD vendors, grievance and appeals** **AVP, UM Nursing** **UM RNs (transplant, behavioral health, appeals, etc.)** **Lead Dental Director** **Dental MD/RN review, bid season benefit review** **Director, Strategy Advancement** **Market liaison, provider/facility relationships** **AVP, UM Administration** **UM intake, vendor management, administrative support** **Role Impact:** - Drive the formation, execution, and sustainability of Humana's Utilization Management strategy. This executive role is responsible for integrating and overseeing all Outpatient and Inpatient based MDs and RNs and non-clinical support for UM functions in Medicaid and Medicare, with a focus on streamlining processes, ensuring consistent clinical practices, driving trend savings, improving Star Ratings, and enhancing operational efficiency.
Highmark HealthMedical Director Highmark HealthMedical DirectorOlympia, WAPreferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral & Written Communication Skills + Collaboration + Listening + Telephone Skills + General Computer Skills + Clinical Software + Managed Care **Language (Other than English)** None **Travel Required** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** Position Type Office-Based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. **EDUCATION** **Required** + Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/Management or Public Health **EXPERIENCE** **Required** + 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry **LICENSES AND CERTIFICATION** **Required** + Medical Doctor or Doctor of Osteopathic Medicine (DO) + Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards + Active medical state licensure required.