Oklahoma Medicaid CMO, RVP Health Services


Non clinical

The OK Medicaid CMO, RVP Health Services (CMO)relies on medical background to create and oversee clinical strategy for the region. The CMO requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.

Job Description

The CMO will provide medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.

•Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana's Medicaid policies and procedures.

•Participate in Quality Operations including chair Quality Management Committee, complete initial peer review on quality of care complaints, complete peer-to-peer written and verbal communications.

•Oversee administrative budget for regional HSO & Quality Improvement including approve/deny expense reports & requisition requests for department members.

•Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs.

•Manage internal operational/functional relationships related to profitability.

•Well-versed on financial aspects of various levels of risk bearing contracts and possess the ability to gain traction and adoption of the providers.

•Ability to thrive in a highly matrix environment.


Required Qualifications

•8 or more years of management experience

•A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment

•MD or DO degree

•Board Certified in an approved ABMS Medical Specialty

•Excellent communication skills

•5 years of established clinical experience

•Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products

•Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab

Posted April 20, 2021