Posted on
Jun 14, 2021
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Description
The Chief Medical Officer, Group Medicare relies on the medical background to create and oversee clinical strategy for the Group Medicare business. The CMO Group Medicare requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.
Responsibilities
- Provide medical leadership and strategy for the GM business.
- Work with local market utilization management and case management teams for inpatient cases.
- Participate in Quality Operations including Quality Management Committee, monitor initial peer review on quality of care complaints.
- Participate in National, Regional, and local meetings of organizations of interest to Group Medicare.
- Engage in speaking engagements to provide thought leadership on behalf of Humana Group Medicare.
- Oversee quality improvement and HEDIS/STARS metrics to improve with corporate and local market resources.
- Provide guidance for the implementation of regional clinical programs and strategies, as well as, developing and implementing national strategies overall and for individual clients.
- Attend current/future client meetings to deliver insights regarding Humana clinical model of care and other programs designed to positively impact overall member health.
- Be an integral part of the GM Leadership team and lead thought leadership internally and externally on behalf of Group Medicare.
- Assist with network development and provider contracting with various providers and ancillary providers.
- Be well-versed on financial aspects of various levels of risk-bearing contracts.
- Thrive in a matrix environment.
- Work collaboratively with account and sales teams to deliver our superior clinical experience story to all audiences.
Required Qualifications
- A current and unrestricted license in at least one jurisdiction and willing to obtain license.
- Physician (MD/DO), Nurse Practitioner, Physician Assistant, Registered Nurse.
- Excellent communication and presentation skills.
- 5 years of established clinical experience.
- Knowledge of the managed care industry including Medicare, Medicaid, and/or Commercial products.
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website: http://www.humana.com
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