CMO, Utilization Management and Market Insights

Humana Inc; Little Rock (AR); On-site; USD 250,000 - 500,000; Full time

Job summary

Humana Inc. seeks a Chief Medical Officer, Utilization Management to be the clinical strategist and operator for Humana’s UM function.

This executive will align outpatient/inpatient MDs and RNs with enterprise goals, drive star rating improvements, and ensure consistent clinical practices across Medicaid and Medicare. It requires MD/DO with board certification and 10+ years in leadership or UM, plus strong analytical and cross-functional collaboration skills to advance whole-person health

Qualifications

• MD/DO with board certification in a medical specialty.
• Minimum 10 years of leadership and/or UM experience.
• Proven track record in improving health outcomes and Star Ratings.

Responsibilities

• Set clinical strategy and lead the Utilization Management organization.
• Oversee MD and RN integration in UM across Medicaid and Medicare.
• Lead risk management, grievance/appeals, clinical contracting and vendor management.
• Ensure clinician perspectives drive organizational decisions.
• Leverage analytics to inform strategy and performance improvement.
• Sponsor development of clinical talent and leadership pipeline.

Skills

Leadership

Strategic thinking

Healthcare strategy

Stakeholder management

Education

MD/DO degree

Board Certification

Job description

Humana Inc. seeks a Chief Medical Officer, Utilization Management to be the clinical strategist and operator for Humana’s UM function.

This executive will align outpatient/inpatient MDs and RNs with enterprise goals, drive star rating improvements, and ensure consistent clinical practices across Medicaid and Medicare. It requires MD/DO with board certification and 10+ years in leadership or UM, plus strong analytical and cross-functional collaboration skills to advance whole-person health