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Medical Director

Lead a team/organization of 10 associates across three functions: Education of Humana's Market-based associates on how to drive accurate reporting through provider education; Provider communications; policies and procedures aligned to those functions. The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that can contribute to Humana's national planning and operations for Risk Adjustment, Stars, and Interoperability.

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<h3>AVP Stars and Risk Adjustment National Medical Director</h3>Location: Rogers, AR, United StatesEmployment Type: Full-TimePosted on: Apr 28, 2023ProfileThe Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that can contribute to Humana's national planning and operations for Risk Adjustment, Stars, and Interoperability. This role carries a set of individual contributor and leadership responsibilities.Responsibilities<ol><li>Inform HQRI's provider strategy and increase adoption of Humana's Stars, MRA, and interoperability strategy and programs.</li><li>Lead a team/organization of 10 associates across three functions: Education of Humana's Market-based associates on how to drive accurate reporting through provider education; Provider communications; policies and procedures aligned to those functions.</li><li>Serve as HQRI's clinical industry representative (e.g., Conferences; national vendor or provider partners).</li><li>Serve as a coding expert, including working through escalations on coding disputes, policy development or refinement, and coordination and education with providers or Humana associates.</li></ol>Required Qualifications<ol><li>MD or DO degree.</li><li>A current and unrestricted license in at least one jurisdiction.</li><li>Board Certified in an approved ABMS Medical Specialty.</li><li>Excellent communication skills, both written and verbal.</li><li>5 years of established clinical experience.</li><li>Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products.</li><li>Must be passionate about healthcare quality and contributing to an organization focused on maintaining accuracy of coding and documentation to capture the true health status of our members through risk adjustment initiatives.</li><li>Experience with quality assurance and/or regulatory compliance.</li><li>Travel up to 25%.</li></ol>Preferred Qualifications<ol><li>Certification in diagnosis coding (must receive AAPC certification within one year of hire).</li><li>Ability to help develop and use data and analytics to drive sustainable results.</li><li>External communications for physicians and healthcare providers.</li><li>Prior experience leading teams focusing on the accuracy of medical record documentation and diagnosis coding.</li><li>Medical management experience, working with health insurance organizations, hospitals, and other healthcare providers.</li><li>Working knowledge of risk adjustment concepts.</li><li>Internal Medicine, Family Practice, Geriatrics, OBGYN, Hospitalist clinical specialty.</li><li>Detail-oriented and effective listener.</li><li>Experience with Stars, including HEDIS, CAHPS, and HOS.</li><li>Prior experience in a business function or business consulting role.</li></ol>Additional InformationHumana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.Scheduled Weekly Hours: 40Humana 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 <a href="#" rel="nofollow">accessibility resources</a>.Humana Inc. Website:<a href="#" rel="nofollow">http://www.humana.com</a>
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Humana Inc.

AVP Stars and Risk Adjustment National Medical Director

Accounts Receivable

Clinical Medicine

Communication Skills

Conferences

Consulting

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

Data Analysis

Detail Oriented

Documentation

Family Medicine

Geriatrics

Health Insurance

Healthcare Effectiveness Data and Information Set (HEDIS)

Healthcare Providers

Healthcare Quality

Hospital

Insurance Regulations

Internal Medicine

Interoperability

Leadership

Managed Care

Medicaid

Medical Coding

Medical Records

Medicare

Negative Testing

Obstetrics and Gynecology

Operations Planning

Policy Development

Presentation/Verbal Skills

Quality Assurance

Regulatory Compliance

Risk

Team Lead/Manager

Training/Teaching

Willing to Travel

Writing Skills

Capital Markets Placement_feed

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