Oncology Program Lead

Humana

2d • $115,200 - $158,400 • Remote

About The Position

The Oncology Program Lead designs, implements, and optimizes clinical programs that drive quality, safety, and efficiency across healthcare delivery systems. The Clinical Strategy and Program Development Lead works on problems of diverse scope and complexity ranging from moderate to substantial. This role drives improvements in patient outcomes, quality, cost efficiency, and service delivery. Serving as the primary liaison between the organization and the Oncology UM vendor, the Program Lead brings deep expertise in clinical workflows, utilization management, and vendor operations. This role exercises independent judgment in managing complex clinical and operational issues, identifying risks, and implementing effective solutions with minimal supervision.
The Oncology Program Lead ensures adherence to evidence-based practices, regulatory standards, and organizational goals to improve patient outcomes and operational performance. Advises executives to develop functional strategies (often segment specific) on matters of significance.

Requirements

• Registered Nurse (RN)
• 7+ years of experience in vendor management, program management, or clinical operations
• 3-5 years or more of oncology experience in case management, utilization management or quality review or auditing
• Experience applying clinical guidelines and medical policies
• Experience reviewing oncology treatment plans
• Proven ability to manage complex programs and drive performance outcomes
• Advanced analytical, problem-solving, and decision-making skills
• Proficiency in Microsoft Office tools (Excel, Word, Outlook); ability to work with data systems and reporting tools

Nice To Haves

• Master’s degree in Nursing, Healthcare Administration, Public Health, or related field
• Experience working with oncology UM vendors or specialty benefit management program

Responsibilities

• Lead end-to-end management of the oncology UM vendor, including performance oversight, governance, and strategic alignment
• Establish contractual KPIs, SLAs, and quality metrics to ensure delivery of safe, effective, and efficient care
• Analyze vendor performance data, identify trends, and drive continuous improvement initiatives
• Conduct regular business reviews and performance discussions with vendor leadership
• Drives timely closure of IOPs and CAPs
• Ensure adherence to evidence-based oncology guidelines, UM policies, and regulatory standards
• Partner with internal clinical, operations, and compliance teams to optimize workflows and program outcomes
• Evaluate vendor clinical processes and recommend enhancements to improve quality, consistency, and patient experience
• Serve as a subject matter expert in oncology UM programs and clinical operations
• Lead complex initiatives and projects supporting oncology UM program optimization
• Define program objectives, timelines, resource needs, and success metrics; manage execution end-to-end
• Utilize data and analytics to inform decision-making and identify opportunities for efficiency and cost savings
• Drive innovation and scalability within vendor-supported programs
• Support contract development, negotiation, and ongoing management of vendor agreements
• Monitor compliance with contractual obligations and address gaps or risks proactively
• Investigate and resolve invoice, performance, and contractual discrepancies
• Build and maintain strong, collaborative relationships with vendor partners and internal stakeholders
• Collaborate across departments including Clinical, Network, Finance, Compliance, and Operations
• Lead stakeholder forums, executive updates, and cross-functional meetings

Benefits

• medical
• dental
• vision
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

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