Strategic CMO, Utilization Management & Insights

Humana Inc; Honolulu (HI); Remote; USD 350,000 - 650,000; Full time

Job summary

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

The CMO, UM will align outpatient and inpatient MDs and RNs with non-clinical support, drive trend savings, improve Star Ratings, and ensure consistent clinical practices across Medicaid and Medicare. The role focuses on streamlining processes, advancing evidence-based UM reviews, and expanding operational efficiency while partnering with

Qualifications

• MD or DO with current board certification.
• Minimum 10 years of combined leadership and/or UM experience.
• Deep knowledge of medical, clinical, and behavioral science underpinning UM.

Responsibilities

• Set clinical strategy and lead the UM organization.
• Oversee integration of physicians and RNs across Medicaid and Medicare.
• Provide leadership in risk management, grievance and appeals, and UM reviews.
• Leverage analytics to drive performance improvement and Star ratings.

Skills

MD/DO

Board Certification

Leadership

Strategic thinking

Health outcomes

Education

MD/DO degree

Board Certification

Job description

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

The CMO, UM will align outpatient and inpatient MDs and RNs with non-clinical support, drive trend savings, improve Star Ratings, and ensure consistent clinical practices across Medicaid and Medicare. The role focuses on streamlining processes, advancing evidence-based UM reviews, and expanding operational efficiency while partnering with