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Capture Lead, Medicaid Clinical & Population Health Strategy

Humana

Humana

Remote
Posted on Thursday, February 1, 2024

Become a part of our caring community and help us put health first

Humana Healthy Horizons is seeking a Capture Lead, Clinical & Population Health Strategy, to lead initiatives developing and executing strategy to successfully position Humana for capture growth opportunities. This role will work horizontally across the organization, coordinating with Medicaid and Medicare leadership and clinical subject matter experts to synthesize, assess, and translate state requirements into actionable go-to-market clinical strategy. The Lead will consult with growth partners to design and optimize clinical operating model blueprints for viable Medicaid health plans that meet the needs of state clients and populations served in target growth markets.

The Lead, Medicaid Clinical & Population Health Strategy, will advance Humana’s Medicaid products and capabilities to support the strategic direction and growth of the Medicaid and Duals lines of business. This is a unique opportunity for a motivated individual to influence the mission of a leading healthcare company committed to improving the health of the communities it serves.

The Medicaid Capture Management team’s purpose is to successfully position Humana to enter new markets enabling the future of the business. As a centrally positioned strategic function this team coordinates with growth partners across the enterprise and industry to accelerate product strategy and define the operating model for new markets. We deliver value through detailed research, data-driven insights, strategic planning, structured problem solving, and project management rigor.

We are a diverse set of highly skilled people with deep Medicaid subject matter expertise who work in an agile, collaborative environment. To achieve our goals, we empower associates to pioneer simplicity, rethink routine and seek talent with the following attributes:

  • Creative – Adept at research to determine the opportunity and a structured yet flexible approach to problem solving.
  • Adaptive - Rapidly learn new knowledge, skills, and behaviors in response to changing circumstances.
  • Self-sufficient - Ability to navigate complex situations and independently produce high quality deliverables.
  • Consultative – Build/sustain relationships and inform the work of others through actionable, objective insights.
  • Strategic – Forward thinking capable of providing frameworks to maximize ability of limited resources to achieve growth.

Candidates will possess Medicaid managed care operations expertise and have experience in designing solutions for key Medicaid programs and subpopulations. Areas of focus include Care Management, Quality Improvement, Utilization Management, Population Health, Social Determinants of Health, Pharmacy, Behavioral Health, Institutional Long-Term Services and Supports (LTSS), Home and Community Based Services, Medicaid and Medicare integration, D-SNPs, and Self-Directed Services.

The Capture Lead, Medicaid Clinical & Population Health Strategy key responsibilities include:

  • Research and assess prospective new markets. Gather key information on market and regulatory landscape and translate state policy to discern impacts to Humana’s operating model.
  • Coordinate operational teams to translate contract requirements, CMS regulations, market intelligence, and industry best practices into a viable target operating model.
  • Lead cross-functional teams of growth partners and health plan leaders to design high-impact, innovative, and competitive clinical programs, models, partnerships, and initiatives for upcoming growth opportunities.
  • Develop project plans and roadmaps, driving timely completion of clinical deliverables by cross-functional project team.
  • Track project status and report on progress to leadership.
  • Participate in the proposal development process. Provide content and recommendations to help shape responses to state procurements and clearly articulate Humana clinical product strategy.
  • Document and clearly communicate clinical operating model features to relevant teams to support proposal development and transition to implementation.


Use your skills to make an impact

Required Qualifications

  • Must work hours within the Eastern Standard Time Zone.
  • Bachelor’s degree with a strong record of academic achievement.
  • 5+ years of experience in a Medicaid Managed Care Organization OR 5+ years of experience in strategy consulting supporting Medicaid clinical strategy, population health management, or business development.
  • Experience and understanding of the Medicaid ecosystem, managed care health services operations, business development lifecycle, and strategic planning.
  • Experience leading cross-functional teams to design a strategy and/or product.
  • Strong problem-solving ability (i.e. adept at research and generating creative solutions).
  • Ability to operate in a fast-paced environment under tight deadlines and in ambiguous situations.
  • Highly organized and analytical with a strong attention to detail.
  • Advanced Proficiency in Microsoft Office Products (i.e. Word, Excel, PowerPoint, Visio).
  • Adept at quantitative and qualitative research.
  • Excellent verbal and written communication and presentation skills.

Preferred Qualifications

  • Master’s degree in public health or health administration programs.
  • MBA programs with a specialization in Healthcare Management.
  • Project Management and Process Improvement qualifications.
  • Experience and understanding of the delivery system for dual eligibles, including D-SNPs.

Work at Home Requirements

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if approved by leadership.
  • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Additional Information

  • Travel: Role will include travel (10-25% of time)
  • Workstyle: Hybrid Office if you live within commuting distance of our office locations in Tampa, FL or Louisville, KY; Remote if you live outside of Tampa, FL and Louisville, KY
  • Core Workdays & Hours: 8-5pm Monday – Friday; Eastern Standard Time (EST) with flexible scheduling (i.e. occasional nights and weekends)
  • Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$112,400 - $154,900 per year


This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.


About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.