The Market Medical Officer, Commercial will provide insight and thought leadership to develop and maintain relationships across the healthcare ecosystem with a focus on the Employer Group Segment. This role will support business line clinical management goals as well as provide visibility and growth of the Humana brand across commercial/business clients, provider communities, nonprofit and government sectors. Ideally candidate should live in Nashville, TN, but will look at other Tennessee locations.
Works to ensure our Humana Clinical Value Proposition is well represented throughout the business and in all venues
Develops and maintains relationships among various healthcare stakeholders to enhance the Humana business model
Works across multiple areas within the organization to provide medical interpretation and advise leadership on clinical strategies
Engages our key client groups on clinical performance, facilitates discussion of clinical reporting and action planning
Serves as key clinical support for specific employer groups and the book of business as a whole as appropriate
Plays a key role in finalist presentations for the segment
Analyzes segment and market level trends, and brings innovative and engaging initiatives to our clients in the markets to drive trend mitigation strategies
Provides clinical reviews for medical underwriting analyses
Drives integrated multidisciplinary engagement to address improving cost and quality of care
Serves as contact for critical partner relationships with organized medicine, industry partners and state and local health care leaders. Acts as key influence and thought leader in local market communities
A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various state in assigned geography
MD or DO degree
Board Certified in an approved ABMS Medical Specialty
Minimum 5 years of medical management experience within health insurance organizations including external facing responsibilities.
Excellent communication skills
Strong presentation skills
Knowledge of managed care industry, specifically Commercial products
Possess analytic and interpretation skills with prior experience leading to externally focused programs to improve and/or address quality, cost and social determinants of health.
MBA, MPH and/or MMM degree
Experience within Humana
Experience in population health or public health sector with a desire to transform current system
Internal Number: R-249502
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