Your Home Advantage Medical Director

Profile

Description

Your Home Advantage (YHA) is a Humana-owned Healthcare Management Company dedicated to improving clinical and quality outcomes by bridging the gap between the physician's office and the member's home. YHA provides prospective home visits conducted by licensed and trained clinical practitioners who perform In-Home Wellness Assessments (IHWA). The IHWA was established to identify and assess Humana Medicare Advantage members who are at risk of excessive utilization of future health related services and to supplement Humana's Health Assessment Program. The summary of the IHWA is sent to the member's primary care provider to be included in the patient medical records and support the provider in providing comprehensive care to members. If there is no primary care provider (PCP), the YHA practitioners make recommendations to the member to establish care with a PCP for necessary follow-up care.

This program is provided at no cost to eligible members and only requires them to give approval and schedule an appointment for the practitioner to come to their home. In addition to improved patient care, this leads to more reliable coding and reimbursement opportunities. YHA provides an additional opportunity to ensure documentation missed in the provider's office is captured and members that have limited function or resources to travel to see a provider can receive quality care in their home. This process can affect multiple areas within the business including Medicare Risk Adjustment (MRA) and healthcare services.

Responsibilities

Job Title: Your Home Advantage Medical Director

Location: Louisville, KY or Work from Home from any State

Job Description Summary

Is the Clinical Voice for YHA and partners with Home Solutions CMO on building out the home asset eco-system and clinical model

Optimizes quality and documentation practices across YHA and advises leadership on key decisions and product development

Monitors network clinician performance, sets clinical outcome goals and drives improvement in consistency of clinician quality and documentation results.

Supports HCC coding best practice guidelines and consults with YHA coding team for clinical insights

Will have 3-4 clinical managers (associate directors) for network field management

Team will: complete performance evaluations; provide 1:1 training; design enterprise quality and training; support continued integration in care continuum with regional provider teams

Clinical oversight for all network clinicians (500 W-2, 1099)

Required Qualifications

MD or DO degree

2 or more years of project leadership experience

5 years of established clinical experience

A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment

Board Certified in an approved ABMS Medical Specialty

Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products

Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Excellent communication skills

Preferred Qualifications

Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.

#physiciancareers

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com