VP, Physician Review, Market Insights

🕒 June 5

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👔 Vice President

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 52%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Set clinical strategy and lead Humana’s Utilization Management organization • Oversee the integration of medical doctors and registered nurses in Utilization Management 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 is central to organizational decision-making • Leverage analytics to inform strategy and performance improvement • Sponsor the development of clinical talent and leadership pipeline • Drive the formation, execution, and sustainability of Humana’s Utilization Management strategy • Challenge the healthcare status quo to improve quality, Star Ratings, and health outcomes • Integrate evidence-based approaches for UM reviewers • Support Humana’s commitment to whole-person health and consistent, high-quality outcomes • Lead a significant functional organization with accountability for human capital and organizational performance • Oversee direct reports across physician leadership, clinical contracting, physician review, quality improvement, legal MDs, MD vendors, grievance and appeals, UM nursing, dental review, strategy advancement, and UM administration

🎯 Requirements

• MD/DO • Current board certification • Minimum 10 years of combined leadership and/or Utilization Management experience • Passion for improving Star Ratings, review consistency, and health outcomes • Deep knowledge of medical, clinical, and behavioral science underpinning Utilization Management • Strong interpersonal, leadership, and business acumen • Proven ability to drive cross-functional results and champion clinical perspectives • Minimum download speed of 25 Mbps and upload speed of 10 Mbps for home internet • Dedicated workspace without ongoing interruptions to protect member PHI / HIPAA information

🏖️ Benefits

• Remote work arrangement • Occasional travel to Humana offices for training or meetings may be required • Dedicated workspace requirement to protect member PHI / HIPAA information • Self-provided internet service support, with minimum 25 Mbps download and 10 Mbps upload requirements • Full-time schedule of 40 hours per week