Chief Medical Officer - Group Medicare

CenterWell Home Health • Louisville, KY

15d • Remote

About The Position

Become a part of our caring community and help us put health first The Chief Medical Officer (CMO), Group Medicare leads and is accountable for the clinical performance of a $12B in revenue Group Medicare Segment and will serve as a key member of the Group Medicare Leadership Team, directly responsible for and overseeing multiple teams within Group Medicare. Will develop, articulate and advance the clinical vision and mission both within the organization and externally with Clints to drive outcomes and performance for the overall team. With deep clinical expertise, the CMO develops and oversees national Group MA's clinical strategy, contributing across interdepartmental organizational segments and influencing enterprise-wide integration. The CMO owns decisions that will impact long term strategy and ensure the business division exceeds outcomes related but not limited to trend, pharmacy, UM, clinical performance, risk adjustment, and stars. This CMO frequently interacts with the senior management team when representing Group MA with the Group MA SVP. In this capacity, the CMO provides strategic leadership on interdepartmental initiatives that align with enterprise-wide initiatives - most commonly working with National Medical, Pharmacy, Risk Adjustment, Stars, Product Design, Trend Bender, and Network operations leaders. The role monitors Groups clinical performance and to implement trend mitigation and risk adjustment programs with ownership of developing new methods and programs within the Group MA membership population. The CMO ensures that clinical strategies support high-quality, equitable, and cost-effective care for Humana's Group Medicare members, fostering innovation while maintaining compliance with regulatory standards. Additionally, the Chief Medical Officer (CMO), Group Medicare, proactively cultivates and sustains external relationships with CMOs from our Group clients. In this capacity, the CMO serves as an executive clinical ambassador for Humana, engaging in peer-to-peer discussions and providing expert guidance on complex clinical matters, thereby strengthening collaboration and trust between Humana and its partners.

Requirements

• A current and unrestricted medical Physician (MD/DO) license in at least one jurisdiction.
• Demonstrates exceptional communication and presentation skills, effectively translating complex clinical initiatives into clear, actionable messages. Adept at engaging in peer-to-peer discussions with Group client CMOs, as well as presenting sophisticated topics in accessible, layperson terms to external business leaders. This ensures broad understanding, alignment, and support for Group Medicare strategies across diverse audiences.
• 10+ years of established clinical experience.
• Knowledge of the managed care industry including Group Medicare, Medicare, Medicaid and/or Commercial products.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Ability to travel nationally 30% of the time.

Responsibilities

• Executive oversight of the planning, staffing and budgeting related to various Group MA clinical teams: clinical trend, analysis, stars and overseeing and managing all Enterprise-wide clinical changes, trends and methods that impact Group Medicare.
• The CMO is responsible for the stars outcomes for Group MA and making highly visible decisions and developing Group specific Stars quality improvement programs to ensure Group Medicare members close gaps in care for HEDIS and Patient Safety and have results trending to 4 or 5 stars.
• Collaborating with corporate and regional teams to implement targeted interventions that promote equitable access to preventive, chronic, and acute care services.
• Owns and is responsible for trend mitigation strategies for Group Medicare and outcomes ranging between $50-$150M annually on National and regional scopes.
• Leading a complex Risk Adjustment strategy to optimize accurate diagnosis capture through comprehensive clinical documentation and coding practices, ensuring Group Medicare members are included and participating for optimal results. Requires operational change management and influence and overall ownership for Group Medicare. Will synthesize CMS regulatory changes related to but not limited to risk adjustment and develop corporate methods that can advance the business forward.
• Makes decisions on cross functional activities: Trend Stewardship, Value Based Care, Risk Adjustment, Stars, Corporate Clinical, Product, Pharmacy, CAPI, and Network—to identify and mitigate negative trends.
• Identifying emerging clinical trends in member health status, utilization, and cost; developing and presenting actionable reporting to employer group clients, internal leadership, and stakeholders.
• Developing and executing strategies to engage employer group plan sponsors in clinical initiatives, population health management, and value-based care, leveraging deep knowledge of risk-bearing contracts.
• Serves as executive clinical advisor and thought leader to group plan sponsors and executive leadership to advance member health, experience, and satisfaction.
• Owns clinical RFP responses that set the Group MA course for the next 3-5 years, and ability to communicate out Humana's superior clinical experience at finalist meetings with State and executive partners which is a key element in these meetings which if won are worth upwards of $1B in revenue.
• Functions as external face, representing Humana and Group Medicare clinical at many National conferences, and with many speaking engagements annually.
• Providing guidance to Group Medicare customers on Utilization Management processes and CMS guidance and collaborating with the UM Centralization team to resolve concerns.
• Guiding the implementation of regional and national clinical programs and strategies tailored to individual clients.
• Participating in national, regional, and local meetings of organizations relevant to Group Medicare, and engaging in speaking opportunities to provide thought leadership for Humana Group Medicare.
• Assisting with network development and provider contracting, as well as product development to support consumer-centric benefit packages and trend mitigation.
• Effective planning and staffing across multiple teams, including Stars, clinical data analytics, trend mitigation, taking ownership of Group MA's clinical initiatives enabling measurable improvements in clinical outcomes and business success.
• Ability to influence and collaborate by guiding teams outside of direct reporting lines while maintaining clear, strategic communication with senior leaders.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees