VP, Physician Review, Market Insights

Humana

Chief Medical Officer overseeing Utilization Management for Humana, integrating clinical and operational leadership for Medicaid and Medicare services.

Posted 6/5/2026full-timeRemote • 🇺🇸 United StatesLeadWebsite

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Hard Skills

Utilization Managementrisk managementclinical contractingvendor managementanalyticsperformance improvementclinical talent development

Soft Skills

leadershipinterpersonal skillsbusiness acumencross-functional collaborationchampioning clinical perspectives

Certifications & Qualifications

MDDOBoard Certification

Industry Keywords

MedicaidMedicareStar Ratingshealth outcomesclinical sciencebehavioral science

About the role

Key responsibilities & impact

Set clinical strategy and lead the Utilization Management organization.
Oversee the integration of medical doctors and registered nurses in UM 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.

Requirements

What you’ll need

MD/DO
Current Board Certification
Minimum 10 years of combined leadership and/or UM experience
Passion for improving Star Ratings, review consistency, and health outcomes
Deep knowledge of medical, clinical, and behavioral science underpinning UM
Strong interpersonal, leadership, and business acumen
Proven ability to drive cross-functional results and champion clinical perspectives.

Benefits

Comp & perks

Health insurance
401(k) matching
Flexible work hours
Paid time off
Remote work options