Chief Medical Officer, Utilization & Market Insights

Humana Inc; Cheyenne (WY); On-site; USD 320,000 - 450,000; Full time

Job summary

Humana Inc. seeks an accomplished Chief Medical Officer, Utilization Management (UM) to lead the clinical strategy and operations for Humana’s UM division. This executive will align medical leadership with enterprise goals, oversee MDs/RNs in Medicaid and Medicare, and drive clinical consistency and efficiency.

The role focuses on improving Star Ratings, reducing cost trends, and embedding evidence-based UM review. Travel to Humana offices may be required, with remote work options available.

Qualifications

• MD/DO with current board certification and leadership experience in UM.
• Minimum 10 years of combined leadership and utilization management experience.
• Strong knowledge of Medicare/Medicaid UM, star ratings, and clinical operations.

Responsibilities

• Set clinical strategy and lead the Utilization Management organization.
• Oversee integration of physicians and RNs across Medicaid and Medicare in UM.
• Provide leadership in risk management, grievance/appeals, and clinical contracting.
• Drive analytics-informed strategy and performance improvement.
• Develop and sustain clinical talent and leadership pipeline.

Skills

Leadership

Strategic thinking

Healthcare analytics

Stakeholder management

Education

MD/DO

Board Certification

Job description

Humana Inc. seeks an accomplished Chief Medical Officer, Utilization Management (UM) to lead the clinical strategy and operations for Humana’s UM division. This executive will align medical leadership with enterprise goals, oversee MDs/RNs in Medicaid and Medicare, and drive clinical consistency and efficiency.

The role focuses on improving Star Ratings, reducing cost trends, and embedding evidence-based UM review. Travel to Humana offices may be required, with remote work options available.