Description

Humana’s Primary Care Organization is one of the largest and fastest growing value-based care, senior-focused primary care providers in the country, operating over 175 centers across eight states under two brands: CenterWell & Conviva. Operating as a payor-agnostic, wholly owned subsidiary of Humana, our centers put the unique needs of seniors at the center of everything we do. Our Clinics offer a team-based care model where our physicians lead a multi-disciplinary care team-supporting patient’s physical, emotional, and social wellness. 50-70% travel to/from Tampa, Sarasota, Lee, Collier counties. Based in Tampa FL.

Responsibilities

IPA Clinical Consultant and Medical Leader (CCML) will influence change and drive patient outcome and provider satisfaction in a value based care setting.

The IPA Clinical Consultant and Medical Leader (CCML) has similar job duties as a Physician, namely focusing on outpatient medicine, continuity of care, health maintenance, and disease prevention. The CCML serves as a health-care professional and capable of handling a variety of health-related problems.

The CCML will spend 80-90% of their time influencing change, drive patient outcome and provider satisfaction focused on direct patient care, with the remaining time dedicated to clinical and administrative duties related to oversight of clinical provision of care in their area.

Will require overnight stay up to partial week depending on the visiting market and number of provider sites.

Meet with clinician leader(s) on a regular basis to review:

• Utilization patterns and opportunities
• Coordinate clinical program offerings to provide for resource management
• Share clinical and practice experience to drive efficiency with IPA clinical leader
• Education for clinical documentation not limited to Medicare Risk Adjustment
• Review of HEDIS/STARS benchmark and opportunities to meet goals
• Review and identify financial opportunities as to Provider Center(s) performance
• Maximize incentive bonus opportunities that the Provider participate in with trend analysis
• Engage providers and community clinical partners to identify growth opportunities for network development
• Pharmacy overview for cost savings opportunities and clinical opportunities
• Collaborates, partners with operational counterpart and leadership to co-create, co-lead to meet market strategic objective. Travel is required.
• Requires a solid understanding of how organization capabilities interrelate across multiple clinics/centers.
• Supervise/mange assigned clinicians designated to market.
• Decisions are typically related to identifying and resolving complex technical and operational problems within clinics/centers.
• Clinician’s PTO management in collaboration with Center administrator, including holiday schedules and as determined by the organization.
• Management of CME time and reimbursement requests.
• Service recovery reports (Patient complaints).
• Guidance to individual clinicians about patient terminations, in collaboration with compliance.
• Manage behavioral concerns pertaining to assigned clinicians.
• Provide support to on site clinicians with logjams and workflow issues.
• Oversight of provider quality and development of workflows to help close gaps in quality.
• Schedule at least one half day at clinic site for onsite visit per week.
• Support clinicians with schedule templates, coverage, daily issues.
• Assist with panel management.
• Oversight of quality of assigned team members.
• Meet with Regional CAs and other AMD at least monthly.
• May be assigned to organizational committees as needed, to attend and represent the clinical perspective of the market.
• Assist in Ongoing Chart Review monitoring.
• Assist with recruitment and interviewing as requested.
• In collaboration with RMD, complete performance reviews as required.
• Participate as backup on call.
• Assist in organizing team building activities.
• Maintain regular clinic hours for a percentage of FTE as determined with Regional Medical Director, as detailed on the clinical job description.
• Serve as a community representative for Conviva IPA in media and press activities

The work at home position must be Florida based in the Tampa-Gulf Coast Region, to better understand the demographic and environment of the different clinical communities.

Florida Licensed and BC.

Required Qualifications

• Doctor of Medicine or Osteopathic Medicine
• Board certified in Geriatric Medicine, Family Medicine or Internal Medicine
• American Board of Physician Specialties (ABPS) is also recognized by our organization
• Valid, unrestricted license in the state of desired employment
• Experience leading Manage Care, Valued Base Care model centers
• Experience leading clinical practice operations
• Demonstrate a high level of skill with interpersonal relationships and communications with colleagues/patients
• Willingness and ability to learn/adapt to practice in a value based care setting
• Basic computer skills, including email and EMR
• This role is considered patient work at home with over 80% travel and some clinical duties, and is part of our Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB

Preferred Qualifications

• 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

Additional Information

• Guaranteed base salary + semi-annual bonus
• Excellent benefit package – health insurance effective on your first day of employment
• CME Allowance/Time
• Occurrence Malpractice Insurance
• Relocation and sign-on bonus options
• 401(k) with Employer Match
• Life Insurance/Disability
• Paid Time Off/Holidays
• Minimal call

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.

Scheduled Weekly Hours

40