Remote Chief Medical Officer, Utilization Management

Humana Inc; Carson City (NV); Remote; USD 300,000 - 600,000; Full time

Job summary

Humana Inc. seeks a Chief Medical Officer, Utilization Management (UM) to serve as the clinical strategist, operator, and visionary for Humana’s UM.

This executive leads MDs, RNs, and non-clinical support across Medicaid and Medicare, driving trend savings, improving Star Ratings, and enhancing efficiency. The role emphasizes evidence-based UM review, clinical leadership, and alignment with Humana’s enterprise objectives.

Qualifications

• MD/DO with board certification and 10+ years of leadership/UM experience.
• 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, grievance and appeals, clinical contracting, vendor management, and UM dental review.
• Ensure the clinician’s perspective informs organizational decisions.
• Leverage analytics to inform strategy and performance improvement.
• Sponsor development of clinical talent and leadership pipeline.

Skills

Leadership

Healthcare analytics

Stakeholder management

Education

MD/DO

Board Certification

Job description

Humana Inc. seeks a Chief Medical Officer, Utilization Management (UM) to serve as the clinical strategist, operator, and visionary for Humana’s UM.

This executive leads MDs, RNs, and non-clinical support across Medicaid and Medicare, driving trend savings, improving Star Ratings, and enhancing efficiency. The role emphasizes evidence-based UM review, clinical leadership, and alignment with Humana’s enterprise objectives.