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Chief Medical Officer

2 months ago

Juneau, Alaska, United States Humana Full time
Position Overview
The Chief Medical Officer at Humana plays a pivotal role in our healthcare community, ensuring that we prioritize health and wellness. This position leverages a robust medical background to assess health claims and make informed decisions regarding service authorizations.

Key Responsibilities
The Chief Medical Officer's duties encompass a range of complex issues requiring thorough analysis and evaluation of various factors. The role involves:
1. Utilizing medical expertise to determine the appropriateness of requested services and levels of care.
2. Engaging with national clinical guidelines and CMS policies to ensure compliance in all medical determinations.
3. Conducting computer-based reviews of clinical scenarios, prioritizing tasks, and communicating decisions effectively to internal teams.
4. Collaborating with external physicians to gather necessary clinical information and resolve conflicts when needed.
5. Overseeing coding practices, clinical documentation, and grievance processes within the scope of the role.

Qualifications
The ideal candidate will possess:
- An MD or DO degree with current Board Certification in an approved ABMS Medical Specialty.
- A minimum of 5 years of direct clinical patient care experience, preferably in an inpatient setting or with Medicare populations.
- A valid and unrestricted medical license in at least one jurisdiction.
- Strong communication skills and the ability to analyze complex data.

Preferred Qualifications