Regional Vice President, Health Services - Illinois Medicaid

Job description

Become a part of our caring community The Chief Medical Officer (CMO) oversees our Illinois FIDE DSNP and Medicaid clinical programs while interacting with Members and Providers to improve patient experience, drive Population Health, and ensure efficient delivery of care. The individual in this role is based in Virginia and works closely with health plan leadership to integrate the day-to-day administration and strategic management of physical and behavioral health services, including utilization management (UM), quality improvement, and value-based payment programs. The Chief Medical Officer also oversees the development of new clinical products and services. POSITION RESPONSIBILITIES: Use your skills to make an impact - Oversees administration of UM, Care Management, Quality Management, Population Health and Pharmacy activities, including major clinical and quality management components - Leads development, implementation, and medical interpretation of clinical policies and procedures including, but not limited to, service authorization, claims review, discharge planning, referral management, UM, and medical review included in Humana’s Complaint, Grievance, and Appeals system for...