Chief Medical Officer – CMO

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Develop and manage the clinical strategy for the designated region.

• Provide medical leadership and strategic direction for Health Services Operations, ensuring fiscal responsibility in trend management.

• Supervise regional utilization and case management for inpatient cases, LTSS services, and the Humana Medicare Model of Care.

• Lead the Quality Management Committee and engage in Quality Operations.

• Conduct initial peer reviews on quality-of-care complaints.

• Facilitate peer-to-peer communications through both written and verbal channels.

• Manage the administrative budget for regional Health Services Operations and Quality Improvement.

• Approve or reject expense reports and requisition requests from department staff.

• Oversee Quality Improvement initiatives and enhance HEDIS/STARS metrics in collaboration with PCP offices and IPAs.

• Participate in regional committees and meetings that establish medical necessity strategies.

• Direct and oversee the implementation of clinical programs and strategies at the regional level.

• Create and execute market-level strategies.

• Manage internal operational and functional relationships to ensure profitability.

• Assist with provider contracting and network development efforts.

• Act as the clinical liaison with inpatient facilities and joint operating committees.

• Maintain relationships with facilities and resolve issues, including reviewing contracts related to clinical services.

• Utilize knowledge of financial aspects of risk-bearing contracts to enhance provider engagement and adoption.

• Thrive in a complex, matrixed environment.

⛳️ Requirements

• MD or DO degree is required.

• A minimum of 8 years of management experience.

• Must possess a current and unrestricted license in at least one jurisdiction, with a readiness to obtain licenses as necessary for various states in the assigned region.

• Board Certified in an approved ABMS Medical Specialty.

• Strong communication skills are essential.

• At least 5 years of established clinical experience.

• Familiarity with the managed care industry, including Medicare, Medicaid, and/or Commercial products.

• Skills in analysis and interpretation, with prior experience leading teams in quality management, utilization management, discharge planning, and/or home health or rehabilitation.

• A passion for contributing to an organization dedicated to continuously enhancing consumer experiences.

• Preferred: experience in medical management with health insurance organizations, hospitals, and other healthcare providers, as well as patient interaction.

• Preferred: clinical specialization in Internal Medicine, Family Practice, Geriatrics, Hospitalist, ER, or PM&R.

• Preferred: a Master’s Degree.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload is required.

• Capability to work from a dedicated space without constant interruptions to ensure the protection of member PHI/HIPAA information.

• Willingness to travel 20% within Michigan and to the corporate office in Kentucky.

🏝️ Benefits

• Bonus incentive plan based on individual and/or company performance.

• Comprehensive 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 coverage.

• Long-term disability coverage.

• Life insurance benefits.

• Requirement for a dedicated home workspace to ensure the protection of member PHI/HIPAA information.

• Remote work arrangement available.

• Occasional travel to Humana offices for training or meetings.