Dermatologist – Miami

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.

Role: Clinical Innovations / Clinical Advisor, MD
Assignment: Dermatologist
Location: Westchester, Kendall and South Dade

Are you a fit?
Do you enjoy defining clinical strategy for a major market area? Do you have a desire to be in a position where you can 'provide guidance to our members related to their health care needs?
Assignment Capsule
You will collaborate with other health care givers in reviewing actual and proposed medical care and services against established DOI guidelines.

• Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design.
  
• Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally.
  
• Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols.
  
• Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria.
  
• Conduct admission review, post-discharge calls and discharge planning.

Key Competencies

• Leveraging Technology: You are technological savvy and know how to appropriately share and use your knowledge to improve business results.
  
• Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
  
• Is Accountable: You meet clearly stated expectations and take responsibility for achieving results.
  
• Clinical Knowledge: You understand clinical program design, implementation, management/monitoring to support choice in consumer medical care. Understands the medical utilization implications of such programs
  
• Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.

Role Essentials

• Current MD license in the state(s) in which you are required to practice
  
• Ability to be licensed in multiple states without restrictions
  
• Advanced work experience in a medical practice experience either a hospital setting or private practice

Role Desirables

• Health Plan experience
  
• Previous Medicare/Medicaid Experience a plus
  
• Previous experience leading teams focusing on utilization management, discharge planning and/or home health or rehab
  
• Bilingual is a plus

Reporting Relationships
You will report to a Regional CEO. This area is under the leadership of the SVP & Chief Operating Officer.
Additional InformationAble to travel to South Dade, Kendall, Westchester locations as needed and according to schedule.

• Have reliable transportation and in good standing State Driving License.
  
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