Provides medical interpretation and clinical review for appropriateness of services, including Home Care Solutions, Skilled Nursing Facility, Durable Medical Equipment, rehabilitation, and discharge planning.
Advises executives on functional strategies related to OneHome initiatives and clinical priorities, exercising independent judgment on complex issues.
Ensures compliance with CMS guidelines, Medicare/Medicaid requirements, and Humana policies while supporting quality, utilization management, and care coordination.
Humana is a leading U.S. healthcare company providing insurance and healthcare services through its Humana insurance and CenterWell healthcare services. It is a large, publicly traded organization with a culture focused on the Humana Way, emphasizing collaboration, accountability, and improving member experiences.
Manage a panel of complex pediatric patients and oversee comprehensive care plans.
Lead a multidisciplinary team to provide wraparound virtual care.
Serve as the face of Imagine Pediatrics in external engagement and community outreach.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, working alongside families, providers, and health plans.
Conduct telehealth visits to establish medical necessity for care navigation and identify high-risk conditions.
Document findings with accurate coding, including SDOH Z-codes and risk factors.
Develop and approve individualized care plans aligned with medical treatment plans.
Baba is rebuilding healthcare for older adults by pairing them with expert advocates who coordinate care. Backed by top tier investors, Baba supports thousands of families across assisted living, nursing homes, and at-home settings.