The Chief Medical Officer (CMO) oversees our Illinois FIDE DSNP and Medicaid clinical programs while interacting with Members and Providers to improve patient experience, drive Population Health, and ensure efficient delivery of care. The individual in this role is based in Virginia and works closely with health plan leadership to integrate the day-to-day administration and strategic management of physical and behavioral health services, including utilization management (UM), quality improvement, and value-based payment programs. The Chief Medical Officer also oversees the development of new clinical products and services.
POSITION RESPONSIBILITIES:
• Oversees administration of UM, Care Management, Quality Management, Population Health and Pharmacy activities, including major clinical and quality management components
• Leads development, implementation, and medical interpretation of clinical policies and procedures including, but not limited to, service authorization, claims review, discharge planning, referral management, UM, and medical review included in Humana's Complaint, Grievance, and Appeals system for Members and Providers
• Ensures compliance with federal and state laws and programmatic requirements concerning medical care
• Regularly meets with the Provider Services team and key stakeholders to maintain alignment on State objectives and goals
• Collaborates closely with corporate and local Population Health teams to identify community partnerships, activities, interventions, and initiatives surrounding health related social needs.
• Accountable for quality standards across Humana's Illinois FIDE SNP and Medicaid Clinical Program
• Serves as co-chair of and participate in meetings of the Medicaid Quality Committee
• Chairs the UM Committee and co-chair the Quality Assessment and Performance Improvement Committee
Use your skills to make an impact
Required Qualifications:
• MD or DO degree
• 8 or more years of management experience
• A current and unrestricted license in Illinois/must reside or willing to relocate to Illinois
• Board Certified in an approved ABMS Medical Specialty
• Excellent communication skills
• 5 years of established clinical experience
• Familiarity with Medicaid stakeholders and Providers
• Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
• Excellent communication skills
• Passion for contributing to an organization focused on continuously improving consumer experience
Preferred Qualifications
• Three years of experience working with Medicaid plan Enrollees in a clinical or administrative setting
• Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
• Internal Medicine, Family Practice, Geriatrics, Hospitalist, ER, PM&R clinical specialists
• Master's Degree
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$327,700 - $450,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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