Corporate Medical Director Healthcare Quality Reporting amp Improvement

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Job Information

Humana

Corporate Medical Director, Healthcare Quality Reporting & Improvement

in

Louisville

Kentucky

Description

The Corporate Medical Director for Healthcare Quality Reporting and Improvement (HQRI) relies on medical background and industry-standard clinical / coding guidance to ensure medical record diagnosis coding accuracy and consistency across the enterprise. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Corporate Medical Director for HQRI leads the Clinical Support Team, composed of clinical and coding associates, and ensures alignment of internal coders and external educators / providers on best practices for diagnosis coding and medical record documentation. Responsibilities include management of the Coding & Policy Review Subcommittee and the Medical Record Review Subcommittee. In addition, the position provides supportive clinical and coding expertise across the teams in HQRI. This position reports to the Senior Vice President for Healthcare Quality Reporting and Improvement.

Required Qualifications:

MD or DO degree

A current and unrestricted license in at least one jurisdiction

Board Certified in an approved ABMS Medical Specialty

Certification in diagnosis coding

Excellent communication skills, both written and verbal

5 years of established clinical experience

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 the accuracy of medical record documentation and diagnosis coding

Must be passionate about contributing to an organization focused on maintaining accuracy of clinical information and regulatory compliance

Preferred Qualifications:

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

Working knowledge of risk adjustment concepts

Internal Medicine, Family Practice, Geriatrics, OBGYN, Hospitalist clinical specialty

​Detail oriented and effective listener

Additional Information

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

Provide proof of full vaccination or commit to testing protocols

*OR  *

Provide proof of applicable exemption including any required supporting documentation

​​Medical, religious, state and remote-only work exemptions are available.

The Corporate Medical Director oversees the work of Medical Directors who conduct clinical case reviews of the care received by members in an assigned market, member population, or condition type. Though the Corporate Medical Director may serve as an expert in a particular condition or functional area, they do not typically spend time engaging in case reviews directly. Typically reports to a member of the corporate executive team (HGO CMO, Office of the CMO, etc.). Supervisory responsibility of other physicians (and perhaps clinicians) is expected. This position should not be used in the same organization as the Regional Medical Director.

Scheduled Weekly Hours

40

Company info

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