National Physician Leader, OneHome Expansion

Humana

4d • $298,000 - $409,800 • Remote

About The Position

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.

Requirements

• 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

Nice To Haves

• 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 partner—not a barrier Teams are engaged, accountable, and aligned Clinical decisions consistently balance quality, experience, and cost You are influencing not just cases—but the future of care delivery

Responsibilities

• 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
• 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
• 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
• 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
• Improve utilization management workflows, turnaround times, and consistency
• Ensure regulatory compliance and audit readiness
• Optimize staffing models and clinical resource deployment
• Care management
• Provider/network teams
• Clinical program leaders
• Operations and compliance
• Act as a key clinical voice across OneHome and Humana

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Education Level: Ph.D. or professional degree