Associate Vice President, Trend & Clinical Innovation Strategy

Humana

2d • Remote

About The Position

Become a part of our caring community and help us put health first The Associate VP, Strategy Advancement provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Associate VP, Strategy Advancement requires a in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide. The Associate VP, Trend & Clinical Innovation Strategy will play an important role within Clinical Operations at Humana to define, prioritize and execute on utilization management-focused initiatives to drive appropriate care to improve cost of care and clinical outcomes; identify efficiencies; and improve experiences across members, associates and providers. The AVP, Trend & Clinical Innovation Strategy will lead a multidisciplinary team that blends strategy, policy, clinical and vendor management and will report directly to Vice President, Clinical Ops Cost of Care Strategy. Specifically, this AVP, Trend & Clinical Innovation Strategy will be responsible for: Identifying opportunity areas where we can address our members receiving inappropriate care via requirement of prior authorization, policy optimization and/or consistent policy enforcement Identifying opportunities for reducing provider and member burden by removing prior authorization requirements at the provider, procedure and sub-procedure (e.g., diagnosis code, site of service, etc.) level Identifying opportunities across the auth to claims process (e.g., slippage) Identifying opportunities for integration of CM to improve member adherence to UM decisions/care pathways Managing vended OP UM relationships (e.g., Cohere), including identification of trend and process improvements Partners across enterprise to drive exploration and implementation of identified opportunities. Additional Responsibilities Include: Partner with analytical functions to rigorously study operational analytics, trends and outcomes to identify opportunities in driving appropriate clinical decisions for members through utilization management/prior authorization process Size impact of addressing opportunity including being responsible for assumptions and inputs used by analytic partners through pressure testing and validation using clinical literature, analysis from related initiatives, industry intelligence, feedback from markets/members/providers, etc. Prioritize and manage portfolio of opportunities in order to achieve annual trend targets for Clinical Operations – develop strategic framework, conduct relevant quantitative analyses and feasibility assessments to prioritize highest value strategic initiatives Collaborate with key partners across enterprise to co-develop strategies / priorities – working hand-in-hand with Clinical Operations and Market partners, ensuring connectivity into broader enterprise strategies and with broader clinical assets (such as Care Management, Pharmacy), informing strategies with data-driven insights from Analytics, Health Care Economics Translate strategies into actionable solutions and plans for execution in collaboration with key partners / stakeholders (e.g., technology, operational teams, provider experience, etc.) Provide team of approximately 15 associates with day-to-day leadership to drive progress and alignment for initiatives Develop & execute process to ensure appropriate stakeholders have had opportunity to inform, decide or veto key decisions Outline materials used to communicate and gain feedback on opportunity and solutions to key stakeholders and decisionmakers Determine key metrics and progress milestones to track against Proactively update and solicit senior leader alignment on key decisions through executive-level presentations and discussion facilitation Use your skills to make an impact

Requirements

• 10+ years of strategy advancement experience
• 10 years of healthcare consulting experience
• 8+ years of team management experience, leading large teams
• Utilization management knowledge

Nice To Haves

• Health Plan experience
• Master's Degree
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Responsibilities

• Identifying opportunity areas where we can address our members receiving inappropriate care via requirement of prior authorization, policy optimization and/or consistent policy enforcement
• Identifying opportunities for reducing provider and member burden by removing prior authorization requirements at the provider, procedure and sub-procedure (e.g., diagnosis code, site of service, etc.) level
• Identifying opportunities across the auth to claims process (e.g., slippage)
• Identifying opportunities for integration of CM to improve member adherence to UM decisions/care pathways
• Managing vended OP UM relationships (e.g., Cohere), including identification of trend and process improvements
• Partners across enterprise to drive exploration and implementation of identified opportunities.
• Partner with analytical functions to rigorously study operational analytics, trends and outcomes to identify opportunities in driving appropriate clinical decisions for members through utilization management/prior authorization process
• Size impact of addressing opportunity including being responsible for assumptions and inputs used by analytic partners through pressure testing and validation using clinical literature, analysis from related initiatives, industry intelligence, feedback from markets/members/providers, etc.
• Prioritize and manage portfolio of opportunities in order to achieve annual trend targets for Clinical Operations – develop strategic framework, conduct relevant quantitative analyses and feasibility assessments to prioritize highest value strategic initiatives
• Collaborate with key partners across enterprise to co-develop strategies / priorities – working hand-in-hand with Clinical Operations and Market partners, ensuring connectivity into broader enterprise strategies and with broader clinical assets (such as Care Management, Pharmacy), informing strategies with data-driven insights from Analytics, Health Care Economics
• Translate strategies into actionable solutions and plans for execution in collaboration with key partners / stakeholders (e.g., technology, operational teams, provider experience, etc.)
• Provide team of approximately 15 associates with day-to-day leadership to drive progress and alignment for initiatives
• Develop & execute process to ensure appropriate stakeholders have had opportunity to inform, decide or veto key decisions
• Outline materials used to communicate and gain feedback on opportunity and solutions to key stakeholders and decisionmakers
• Determine key metrics and progress milestones to track against
• Proactively update and solicit senior leader alignment on key decisions through executive-level presentations and discussion facilitation

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive