Chief Medical Officer – CMO

Job not on LinkedIn

🔥 11 hours ago

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $327.7k - $450.6k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Create and oversee clinical strategy for the region • Provide medical leadership and strategy for Health Services Operations with fiscal responsibility for trend management • Oversee regional utilization management and case management for inpatient cases, LTSS services and the Humana Medicare Model of Care • Chair the Quality Management Committee and participate in Quality Operations • Complete initial peer review on quality-of-care complaints • Complete peer-to-peer written and verbal communications • Oversee the administrative budget for regional Health Services Operations and Quality Improvement • Approve or deny expense reports and requisition requests for department members • Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs • Participate in regional committees and meetings that set medical necessity strategies • Oversee and direct implementation of regional clinical programs and strategies • Develop and implement market-level strategies • Manage internal operational and functional relationships related to profitability • Assist with network development and provider contracting • Serve as clinical liaison with inpatient facilities and joint operating committees • Maintain facility relationships and resolve problems, including reviewing contracts regarding clinical services • Apply knowledge of financial aspects of risk-bearing contracts to gain provider traction and adoption • Work effectively in a highly matrixed environment

🎯 Requirements

• MD or DO degree • 8 or more years of management experience • A current and unrestricted license in at least one jurisdiction, with willingness to obtain licenses as required for various states in the region of assignment • Board Certified in an approved ABMS Medical Specialty • Excellent communication skills • 5 years of established clinical experience • Knowledge of the managed care industry, including Medicare, Medicaid and/or Commercial products • Analysis and interpretation skills with prior experience leading teams focused on quality management, utilization management, discharge planning and/or home health or rehabilitation • Passion for contributing to an organization focused on continuously improving consumer experiences • Preferred: medical management experience with health insurance organizations, hospitals and other healthcare providers, and patient interaction • Preferred: Internal Medicine, Family Practice, Geriatrics, Hospitalist, ER or PM&R clinical specialization • Preferred: Master's Degree • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Ability to travel 20% in Michigan and to the corporate office in Kentucky

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Dedicated home workspace requirement supporting protection of member PHI/HIPAA information • Remote work arrangement • Occasional travel to Humana offices for training or meetings