Chief Medical Officer, Utilization & Market Insights

Humana Inc; Santa Fe (NM); Remote; USD 300,000 - 450,000; Full time

Job summary

Humana Inc. is seeking the Chief Medical Officer, Utilization Management (UM) to serve as the clinical strategist and executive for Humana’s UM organization.

This role will oversee MDs and RNs across Medicaid and Medicare, driving trend savings, improving Star Ratings, and enhancing operational efficiency. The CMO, UM will align with Humana’s objectives, sponsor talent development, and lead performance analytics, risk management, and clinical contracting while maintaining a patient-centered,

Qualifications

• MD/DO with board certification and extensive UM leadership experience.
• Deep knowledge of medical, clinical, and behavioral science underpinning UM.
• Strong interpersonal, leadership, and business acumen.
• Proven ability to drive cross-functional results and champion clinical perspectives.

Responsibilities

• Set clinical strategy and lead the Utilization Management organization.
• Oversee the integration of medical doctors and registered nurses in UM across Medicaid and Medicare.
• Provide leadership in risk management, grievance and appeals, clinical contracting, vendor management, and UM dental review.
• 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.

Skills

Leadership

Strategic thinking

Cross-functional collaboration

Stakeholder management

Education

MD/DO

Current Board Certification

Minimum 10 years of combined leadership and/or UM experience

Job description

Humana Inc. is seeking the Chief Medical Officer, Utilization Management (UM) to serve as the clinical strategist and executive for Humana’s UM organization.

This role will oversee MDs and RNs across Medicaid and Medicare, driving trend savings, improving Star Ratings, and enhancing operational efficiency. The CMO, UM will align with Humana’s objectives, sponsor talent development, and lead performance analytics, risk management, and clinical contracting while maintaining a patient-centered,