Medicaid Strategy Lead - Clinical and Population

Medicaid Strategy Lead – Clinical and Population

BECOME A PART OF OUR CARRYING COMMUNITY AND HELP US PUT HEALTH FIRST

The Medicaid Strategy Lead – Clinical and Population will lead initiatives to develop and execute strategy to successfully position Humana to capture growth opportunities and develop operating models. This role will work horizontally across the organization, coordinating with Medicaid and Medicare leadership and population health 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 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.

• Research and assess prospective growth markets. Gather key information on market and regulatory landscape and translate federal and state policy to discern impacts to Humana’s 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 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 product strategy.
• Document and clearly communicate operating model features to relevant teams to support proposal development and transition to implementation.

• 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, managed care health services operations.
• Pre‑RFP proposal development/implementation 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.

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

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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.