About Humana


Job Category:

Integrated Care & Care Operations - Providers


United States

Approximate Salary:

Not Specified

Position Type:

Full Time

Regional Medical Director - Houston

Humana - Wkly Houston, Texas

Posted: 12/7/2018


The Regional Medical Director serves as a health-care professional and capable of handling a variety of health-related problems. The Regional Medical Director requires an in-depth understanding of how organization capabilities interrelate across the function or segment.


Role: Regional Medical Director

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Partners in Primary Care (PiPC), we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At PiPC, we’re seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole.  

Assignment Capsule

As a Regional Medical Director you will plan, organize, manage and supervise health care services offered in the medical centers. Work in conjunction with the Primary Care Physicians to motivate and provide medical direction in pursuit of cost effective, quality healthcare.  Responsible for other PiPC market training in best practices in value based population health for both owned and contracted physician relationships in multiple markets. 

  • Plan, organize, manage and supervise Primary Care Physicians.
  • Identify physician recruitment needs and collaborate in the hiring and contracting of providers.
  • Establish work schedules and assignments for medical staff according to workload, space and equipment and center needs.
  • Oversee daily operations of physician services.
  • Build strong relationship with specialist, hospitalist, SNF and other providers to form a narrow network of quality service focused on senior population health
  • Responsible for medical interpretation, reviews, and decisions as required for plan administration.
  • Monitor medical performance and provide guidance to ensure that the quality of care being provided meets appropriate standards and to ensure cost-effective utilization practices.
  • Oversee the development, revision, and implementation of policies and procedures, systems, programs and standards for health care services.
  • Represent the organization in community and marketing events.
  • Develop and maintain compliance with the departmental and physician budgets.
  • Assess, develop and recommend strategies for compliance with regulatory requirements.
  • Develop and maintain an effective relationship with all departments providing medical guidance and expertise.
  • Develop, implement and monitor the outcomes of utilization review and disease management programs to meet the quality and cost expectation of.
  • Identify trends of over- and under-utilization and implement actions plans to improve.
  • Direct and orient physicians in the correct application of approved guidelines. .
  • Oversee the operations of the wellness activities and medical department.
  • Guide and enforce Perfect Service Standards (Customer Service).
  • Other duties as requested
  • Assist in the development and delivery of MSO training as it relates to MRA best practices.
  • Develop and hold accountable contracted physicians for PiPC in multiple markets.

Role Essentials

  • Board Certified MD/DO in an approved ABMS Medical Specialty (Primary Care Provider highly preferred)
  • Current and unrestricted license in Texas and willing to obtain license, as required, for various states in region of assignment
  • Medical staff leadership experience for a large multi-specialty group practice, physician practice management organization, hospital/hospital system, or an MCO (preferably with a physician group practice component)
  • Knowledge of Medicaid and Medicare programs, specifically Medicare Advantage
  • Strong knowledge of MA coding and documentation policies and procedures in a value based relationship
  • Experience working with physicians to strategize and develop measurable improvements the quality of clinical care and patient satisfaction
  • Medical quality and performance improvement experience
  • Utilization review experience

Role Desirables

  • Excellent oral and written communication skills
  • Experience in eCW
  • Published papers and presentations within the Healthcare community

Key Competencies

  • 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. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
  • 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. Understands the medical utilization implications of such programs
  • Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience


Scheduled Weekly Hours


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