Medicaid Capture Lead - Clinical and Population

Humana

4d • Remote

About The Position

Become a part of our caring community The Medicaid Capture Lead - Clinical and Population will lead initiatives to develop and execute operating models and strategies to successfully position Humana to capture growth opportunities. This role will work horizontally across the organization, coordinating with Medicaid leadership and population health and clinical subject matter experts to synthesize, assess, and translate state Medicaid and integrated dual eligible program requirements into actionable go-to-market strategy. Reporting to the Strategy Execution/Advancement Principal you will consult with growth partners to design and optimize population health and clinical operating model blueprints for viable Medicaid health plans that meet the needs of state clients and populations served in target growth markets. You will possess Medicaid managed care business development and operations expertise and have experience in designing solutions for key Medicaid programs and subpopulations. Areas of focus include Population Health, Social Determinants of Health, Health Equity, Care Management/Coordination, Quality Improvement, Behavioral Health, Interoperability, Long-Term Services and Supports, Home and Community Based Services, and Medicaid and Medicare Integration. Key responsibilities include: o Research and assess prospective Medicaid growth markets. Gather key information on market and regulatory landscape and translate federal and state policy to discern impacts to Humana’s clinical operating model. o Lead cross-functional teams of growth partners and health plan leaders to design high-impact, innovative, and competitive population health and clinical programs, models, partnerships, and initiatives for upcoming growth opportunities. o Coordinate operational teams to translate state contract requirements, CMS regulations, market intelligence, and industry best practices into a viable target operating model. o Develop project plans and roadmaps, driving timely completion of deliverables by cross-functional project team. o Track project status and report on progress to leadership. o Participate in the proposal development process. Provide content and recommendations to help shape responses to state Medicaid procurements and clearly articulate Humana's model. o Document and clearly communicate operating model features to relevant teams to support proposal development and transition to implementation. Use your skills to make an impact

Requirements

• Bachelor’s Degree
• 5+ years’ experience in a Medicaid Managed Care Organization or 5+ years’ experience in strategy consulting supporting Medicaid clinical strategy, population health management, or business development.
• Experience and understanding of the Medicaid ecosystem and managed care health services operations.
• Business development/proposal and/or implementation experience within Medicaid Managed care.
• 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.

Nice To Haves

• Master’s Degree in Public Health, Social Work, or Health Administration programs.
• MBA programs with a specialization in Healthcare Management.
• Project Management and Process Improvement qualifications.

Responsibilities

• Research and assess prospective Medicaid growth markets. Gather key information on market and regulatory landscape and translate federal and state policy to discern impacts to Humana’s clinical operating model.
• Lead cross-functional teams of growth partners and health plan leaders to design high-impact, innovative, and competitive population health and clinical programs, models, partnerships, and initiatives for upcoming growth opportunities.
• Coordinate operational teams to translate state contract requirements, CMS regulations, market intelligence, and industry best practices into a viable target operating model.
• Develop project plans and roadmaps, driving timely completion of 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 Medicaid procurements and clearly articulate Humana's model.
• Document and clearly communicate operating model features to relevant teams to support proposal development and transition to implementation.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees