Primary Care Physician Lead

Humana • Seneca, SC

67d • $223,800 - $313,100

About The Position

The Physician Lead serves as a health-care professional and capable of handling a variety of health-related problems. The Physician Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Physician Lead (PL) serves as a leader to a team of clinicians in a designated market responsible for handling a variety of health-related problems and educating patients and their families on wellness, prevention, and early detection. The PL is responsible for executing the clinical strategy through the management of their own patient panel as well as those of the clinicians whom they lead.

Requirements

• Current and unrestricted medical license or willing to obtain a medical license in state of SC
• Graduate of accredited MD or DO program of accredited university
• Board Certification or Eligible to become certified (ABMS or AOA) in Family Medicine, Internal Medicine or Geriatric Medicine preferred
• Active and unrestricted DEA license
• Excellent verbal and written communication skills
• Demonstrate a high level of skill with interpersonal relationships and communications with colleagues/patients
• Fully engaged in the concept of 'Integrated team-based care' model
• Willingness and ability to learn/adapt to practice in a value-based care setting
• Superior patient/customer service
• Basic computer skills, including email and EMR
• This role is considered patient facing and is a part of our Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Nice To Haves

• Active and unrestricted DEA license
• Medicare Provider Number
• Medicaid Provider Number
• Minimum of three to five years directly applicable experience preferred
• Experience managing Medicare Advantage panel of patients with understanding of Best Practice in coordinated care environment in a value-based relationship environment
• Knowledge of Medicare guidelines and coverage
• Knowledge of HEDIS quality indicators
• Good understanding of best practice coding and documentation in value-based environment
• 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
• 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
• Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience

Responsibilities

• Administrative oversight and outcomes determined by the Clinical / Operational Leadership of the Market
• Spend a portion of time clinically focused on direct patient care, with the remaining time dedicated to administrative duties related to oversight of clinical provision of care
• Working collaboratively with Market CMO and Operational Leadership to advance the Model of Care
• Create profit improvement initiatives
• Design operational implementations
• Contribute to the strategic intent
• Overseeing other clinicians including Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA)
• Maintaining Collaborative / Supervisory Agreements per state protocols
• Assisting with panel management
• Providing direct education to clinicians around clinical protocols / disease prevalence / appropriate levels of clinical quality care
• Providing guidance to individual clinicians about patient terminations, in collaboration with Compliance
• Supporting clinicians with schedule templates, coverage, daily issues
• Managing behavioral concerns of supervised staff
• Assisting with PTO Management
• Assisting with CME time and reimbursement requests
• Assisting with completion of performance reviews
• Assisting in resolution of inquiries, requests, and complaints from clinical staff
• Assisting in organizing team building activities
• Assisting in resolution of inquiries, requests, and complaints from patients
• Ongoing chart review / audit of clinical staff to ensure quality care and identifying opportunities for education/coaching
• Identifying trends and areas of opportunity in pharmacy utilization to impact Part D per Member per Month (PMPM) costs while maintaining high quality care
• Optimizing network; preferred network specialists
• Making decisions related to the identification and mitigation of complex technical and operational problems within clinics/centers
• Managing financial / operational performance of their assigned clinics to ensure success
• Participating in provider committees and attending meetings regularly
• Participating in Shared Service Strategy Meetings
• Participating in quality improvement programs, population health programs, continuing education, and other patient care programs established by clinical requirements
• Assisting in recruiting and interviewing of potential clinical staff
• Participating in patient retention and marketing activities as required
• Serving as a community representative in the media and press activities
• Maintaining confidentiality of all patient information according to both state and federal guidelines and regulations
• Maintaining medical history and medical records
• Ordering studies, tests and ancillary services
• Participating as a back-up on-call physician
• Prescribing medical treatment and clinical drugs to patients
• Referring patients to specialists as needed

Benefits

• Competitive base salary + annual bonus incentive + Relocation & Sign-on bonus opportunities
• 8am-5pm M-F, Full & Flex work hours -no weekends
• Minimal Call
• Comprehensive benefits package-health insurance is effective on your first day of employment
• Life Insurance/Disability
• 401(k) with Employer Match
• Generous Paid Time Off (PTO) + 9 Paid Holidays + 4 Flex Days
• Malpractice provided
• 100% Outpatient, diverse population
• CME Allowance/Time
• Fully integrated, optimized EMR

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Insurance Carriers and Related Activities
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees