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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 OneHome, 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
key advantage vs. traditional UM-only roles
2. Practice High-Impact, Modern Medicine
3. Lead in a Culture Built on Humanity & Performance
Your leadership is guided by The Humana Way
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/OneHome
Opportunity to shape strategyut 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
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 as a trusted clinical partnerut not a barrier
Teams are engaged, accountable, and aligned
Clinical decisions consistently balance quality, experience, and cost
You are influencing not just casesut the future of care delivery
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$298,000 - $409,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, Humana) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 10-27-2026
