VP, Behavioral Health Strategy

Humana

8d•Remote

About The Position

Become a part of our caring community The Vice President, Clinical Strategy for Behavioral Health will lead the transformation and development of Humana’s enterprise-wide Behavioral Health strategy and operating model across Medicare and Medicaid. This leader will be responsible for designing and deploying an innovative, end-to-end behavioral health strategy that improves health outcomes, reduces medical costs, improves operational efficiency, reduces provider and member abrasion, and ensures compliance with state and federal regulations. This role plays a pivotal part in enhancing the overall quality of healthcare services, improving our efficiency and effectiveness in delivering behavioral health care, fostering strong relationships with our internal and external stakeholders. This leader will work with a dedicated team of behavioral health experts and engage with an executive governance committee with balanced representation across Medicare and Medicaid, ensuring cross-functional collaboration and accountability. They will also have an aligned DRI from each member of the governance team and are accountable for the initiative’s success from the POV of their functional / operational area. Use your skills to make an impact

Requirements

Demonstrated experience in clinical leadership and strategy development within managed care or health plan environments.
Proven ability to drive results through influence across a matrixed organization.
Expertise in healthcare operations, technology solutions and process optimization.
Deep knowledge of Medicare and Medicaid regulatory requirements and behavioral health policy.
Track record of identifying and rectifying broken processes and systems with a passion for transformative change with proven ability to drive enterprise-wide transformation.
Strategic and data-driven mindset with strong analytical, operational, and change management skills with proficiency in data analysis tools.
Excellent and straightforward communication, collaboration and problem-solving abilities coupled with the ability to tell the story and manage conflict at all levels of the organization.
Excellent organizational and project management skills; able to track and manage complex enterprise processes and initiatives from start to finish
Working knowledge of financial evaluation and M&A processes with experience with integrating acquisitions preferred

Nice To Haves

Preferred MD or DO, board certified in psychiatry, internal medicine or family practice.

Responsibilities

Develop and execute a comprehensive enterprise-wide behavioral health strategy that sustainably improves clinical outcomes, access, affordability and member experience across insurance segments (Medicare and Medicaid).
Establish and track key success metrics including quality, access and financial metrics, such as medical trend reduction and administrative costs.
Lead a dedicated team of behavioral health experts and engage cross functional teams to ensure collaboration and accountability.
Collaborate with partners across the enterprise to develop, articulate, implement, evaluate, and refine a set of strategic initiatives that address, but are not limited to, the following domains:
Access: Optimize network and benefit design, care management, and referral pathways to ensure timely, high-quality behavioral health care for Humana members.
Medical Cost Management and Outcomes: Identify impactable drivers of poor outcomes and avoidable spending for members with behavioral health needs. Implement cost-effective strategies to address these to drive medical trend reductions and improve outcomes for Humana members.
Analytics and Measurement: Evolve enterprise-wide approach to behavioral health outcome measurement to improve our ability to identify trends, highlight areas for improvement, establish tactics for advancing outcomes, and evaluate impact. Work collaboratively with enterprise teams to evaluate and synthesize data to inform clinically appropriate, cost-effective solutions to advance the behavioral health management of members.
Internal Operations and Technology: Support efforts to enhance operational efficiency in utilization management, claims payment, and provider contracting, minimizing friction for members, providers, and associates.
External Partnerships: Explore, evaluate, and implement novel partnerships with national and community-based organizations to expand Humana’s impact on behavioral health outcomes.
Innovation: Drive behavioral health innovation, including virtual care, specialty care access, and value-based payment models.
Establish and maintain external relationships to ensure awareness of leading-edge innovation and policy changes in behavioral health; represent Humana and Humana’s behavioral health strategy externally.
Lead opportunity analysis and define the target state for Humana’s behavioral health strategy, including success metrics and stakeholder input.
Assess internal and external current state, benchmarking against peer organizations and identifying gaps.
Size opportunity for BH program advancement and assess key developments and trends in BH across Medicare & Medicaid – including 1, 3, 5, 10-year evolution.
Operating Model Recommendation Identify and define options for how to close capability gaps. Understand vendor landscape.
Implement operating model solutions, including build/buy/vendor assessments as needed.
Execution Execute new operating model, ensuring continuity of work-in-progress activity and longer-term strategies.
Effectively transition work to other teams as appropriate