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AVP, Medical Cost Management



Posted on Thursday, September 7, 2023


At Humana, our primary goal is to make health care affordable, while ensuring access, quality, and usability. An effective cost management strategy takes a deep and broad portfolio approach that tailors the plan to local market dynamics and pulls all the levers we have available, including network and plan design, utilization management, service mix management, value-based designs, and member engagement.

The AVP, Medical Cost Management will be instrumental in developing an enterprise-wide Medical Cost Management plan for the business, collaborating with senior leaders across various segments to identify opportunities and solutions and manage the processes and portfolio of initiatives designed to drive over $300M in trend savings over the next several years.


  • Help develop an enterprise-wide Medical Cost Management plan for the business and represent it to leadership and key stakeholders to secure internal buy-in while integrating into annual and multi-year business plans

  • Lead organizational efforts to synthesize medical cost trends, and identify actions to achieve medical and pharmacy cost improvements spanning network and clinical and claims management

  • Utilize historical, predicted, and competitive market data to recommend benchmarks for setting expectations for, and measuring, financial and operating performance (KPIs)

  • Partner with Data Science, Finance, Actuarial, and Clinical / Pharmacy, Network, Product and Claims Cost Management teams to implement best-in-class methods to systematically identify and manage medical cost drivers

  • Develop action plans to address identified opportunities, including researching industry standards, vendor solutions and the build requirements for internal solutions in collaboration with enterprise partners

  • Lead Trend Stewardship process and activities, including planning and organizing quarterly reviews, setting meeting goals, creating agendas, preparation with DRIs, developing presentations, facilitating meeting and managing overall communications to the Trend Stewardship Committee

  • Develop and enhance metrics, reports and models to enable effective monitoring and analysis of network, condition / case management, site of care, and unit cost improvement programs

  • Lead a small team of industry experts to drive actionable insights and analysis to find the largest opportunities and own tangible actions we can take that will maximize our risk-adjustment profitability, medical trend and resulting growth

  • Build strong relationships within the organization including Market Presidents, Market Medical Directors, Clinical Strategy, Clinical Operations, Finance, SPA, and TAF

  • Collaborate with enterprise data and technology partners to ensure the company's data strategy supports program performance monitoring and stakeholder reporting needs

  • Develop, in partnership with key partners, new approaches to improve utilization and health outcomes for members, creatively and flexibly collaborate with providers, and meet product and market demands

  • Work on initiatives in support of advancing standardized metrics such as those promulgated by NCQA/HEDIS, CMS/Star, in support of client demands and Company strategies.

Required Qualifications

  • Bachelor’s degree

  • 10+ years of healthcare industry experience, preferably specific experience working at a payer

  • Demonstrated experience leading cross-functional teams to design and execute complex, large scale initiatives requiring transformation and change management

  • Demonstrated analytic acumen and ability to leverage data to drive decision making and improve outcomes

  • Experience with the principles and processes required to drive medical cost management

  • Proven organization, planning, and prioritization skills

  • Highly collaborative mindset, excellent relationship-building skills, and proven ability to engage and influence stakeholders in a highly matrixed company

  • Excellent oral and written communications skills and the polish, poise, and executive presence that will ensure effective interaction with senior leaders and the ability to lead large, executive-level forums

Preferred Qualifications

  • MBA or other master’s degree

  • Understanding of Humana’s organizational structure, key businesses, and data assets

Scheduled Weekly Hours