Chief Medical Officer, Utilization & Market Insights

Humana Inc; Richmond (VA); Remote; USD 250,000 - 450,000; Full time

Job summary

Humana Inc. in the United States seeks the Chief Medical Officer, Utilization Management (UM) to serve as clinical strategist and enterprise leader for UM across Medicaid and Medicare, aligning with Humana’s strategic objectives.

The CMO, UM will oversee MDs and RNs and drive operational efficiency and clinical consistency. The role requires deep clinical knowledge, executive leadership, and a track record of improving health outcomes and Star Ratings through data-driven decision making and

Qualifications

• MD/DO required and Board Certification expected.
• Minimum 10 years of combined leadership and/or utilization management experience.
• Passion for improving Star Ratings, review consistency, and health outcomes.
• Deep knowledge of medical, clinical, and behavioral science underpinning UM.
• Strong interpersonal, leadership, and business acumen.

Responsibilities

• Set clinical strategy and lead the Utilization Management organization.
• Oversee integration of MDs and RNs in UM across Medicaid and Medicare.
• Provide leadership in risk management, grievances and appeals, and vendor management.
• Ensure the clinician’s perspective is central to organizational decision-making.
• Leverage analytics to inform strategy and performance improvement.
• Sponsor the development of clinical talent and leadership pipeline.
• Drive the formation, execution, and sustainability of Humana’s UM strategy.
• Challenge the healthcare status quo to improve quality and Star Ratings.
• Integrate evidence-based approaches for UM reviewers.

Skills

Leadership

Interpersonal skills

Business acumen

Strategic thinking

Education

MD/DO

Board Certification

Job description

Humana Inc. in the United States seeks the Chief Medical Officer, Utilization Management (UM) to serve as clinical strategist and enterprise leader for UM across Medicaid and Medicare, aligning with Humana’s strategic objectives.

The CMO, UM will oversee MDs and RNs and drive operational efficiency and clinical consistency. The role requires deep clinical knowledge, executive leadership, and a track record of improving health outcomes and Star Ratings through data-driven decision making and