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Be ready to discuss how you set clinical standards for home or post-acute programs, resolve medical-necessity disputes, and scale OneHome-style expansion without eroding quality. Reference Humana’s scale as a major insurer and recent public themes (employer pharmacy partnerships, senior-focused foundation work) only as context for strategy questions—not as insider claims.
Strong fit for a physician leader who has owned clinical governance in a large payer or integrated home-care setting and can translate expansion strategy into safe, consistent medical policy. Weaker fit if you prefer pure hospital administration or hands-on primary care without corporate medical-director scope.
As Corporate Medical Director for OneHome Expansion at Humana, the day centers on clinical leadership for home-based care growth: reviewing medical policy and utilization patterns, aligning clinical standards with OneHome expansion goals, and partnering with operations, network, and care-management teams. Expect case and program reviews, guidance to regional clinical leaders, and decisions that balance member outcomes with coverage and quality expectations in a large Medicare-focused insurer.
Build depth in population health, home-based care models, utilization management, and payer medical-director practice. Strengthen collaboration with product, network, and quality teams; stay current on Medicare Advantage and home-health regulatory expectations. No certification package is specified in available data.
It is a major U.S. for-profit health insurance company based in Louisville, Kentucky, ranked among the largest national insurers (Wikipedia).
The listing is United States–based with remote flagged off (remote: 0); treat it as non-remote unless Humana’s offer says otherwise.
Coverage includes stock/earnings discussion, a statement on a university contract, a Cost Plus Drugs employer-pharmacy partnership, and a Humana Foundation grant tied to senior isolation research—useful only as public context, not job duties.
Website: humana.com
Humana Inc. is an American for-profit health insurance company based in Louisville, Kentucky. In 2024, the company ranked 92 on the Fortune 500 list, which made it the highest ranked company based in Kentucky. It is the fourth largest health insurance provider in the U.S.
Public cache only — not an employee review.
CORPORATE MEDICAL DIRECTOR, ONEHOME EXPANSION Humana United States Full Time - No Remote The Opportunity Join Humana as a Corporate Medical Director for OneHome Expansion. As part of our caring community, you will provide medical interpretation and decisions on the appropriateness of services provided by healthcare professionals in compliance with review policies and procedures. You will advise executives to develop strategic initiatives, exercise independent judgment, and provide clinical leadership to support Humana’s OneHome Expansion programs. Day-to-Day Responsibilities Review health claims and clinical requests to determine medical necessity and appropriateness of care provided by healthcare professionals. Evaluate Home Care Solutions, Skilled Nursing Facility services, Durable Medical Equipment, rehabilitation, discharge planning, and other home-based care solutions. Apply CMS Medicare guidance, Medicare Advantage requirements, Medicaid guidelines, national clinical standards, Humana policies, and performance standards to make informed decisions. Provide medical interpretation and clinical rationale for complex cases. Requirements MD or DO degree with board certification in a relevant specialty. Minimum 5 years of experience as a Medical Director, preferably in home health care or related field. Strong knowledge of CMS Medicare guidance, Medicare Advantage requirements, Medicaid guidelines, and national clinical standards. Proven ability to exercise independent judgment and make complex medical decisions. Excellent communication skills for providing clear medical interpretations and rationales. Why Join Humana At Humana, you will be part of a caring community dedicated to improving the health and well-being of our members. Our commitment to quality care and innovative solutions offers an exciting opportunity for professional growth and development. Be a part of shaping the future of healthcare with us. Apply Today To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.
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