National Physician Leader, One Expansion

Position: National Physician Leader, OneHome Expansion
** 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 One Home, 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/One Home

+  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 One Home 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…