Remote CMO, Utilization & Market Insights

Humana Inc; Hartford (CT); Remote; USD 350,000 - 550,000; Full time

Job summary

Humana Inc. is seeking a Chief Medical Officer for Utilization Management (UM) to serve as clinical strategist and operational leader for Humana's UM functions in Medicaid and Medicare.

The role emphasizes streamlining processes, ensuring consistent clinical practices, and driving Star Ratings and health outcomes. The CMO, UM will align with Humana’s enterprise model, oversee MD/RN integration, and lead a large team including physicians, nurses, and administrators.

Qualifications

• MD/DO required and Board Certification.
• 10+ years of leadership and/or UM experience.
• Deep knowledge of medical, clinical, and behavioral science underpinning UM.
• Strong interpersonal, leadership, and business acumen.

Responsibilities

• Set clinical strategy and lead Humana's Utilization Management organization.
• Oversee integration of MDs and RNs across Medicaid and Medicare.
• Provide leadership in risk management, grievances and appeals, clinical contracting, and vendor management.
• Ensure clinician perspective informs organizational decisions.
• Leverage analytics to drive strategy and performance improvement.
• Sponsor development of clinical talent and leadership pipeline.

Skills

Leadership

Strategic thinking

UM knowledge

Cross-functional collaboration

Analytical skills

Education

MD/DO

Board Certification

Job description

Humana Inc. is seeking a Chief Medical Officer for Utilization Management (UM) to serve as clinical strategist and operational leader for Humana's UM functions in Medicaid and Medicare.

The role emphasizes streamlining processes, ensuring consistent clinical practices, and driving Star Ratings and health outcomes. The CMO, UM will align with Humana’s enterprise model, oversee MD/RN integration, and lead a large team including physicians, nurses, and administrators.