VP, Medicaid Clinical Economics & Quality

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The Vice President, Medicaid Clinical Economics & Quality provides strategic and operational leadership for clinical effectiveness within the Medicaid segment. This function integrates Medical Economics, Clinical Insights, and Quality to deliver improved health outcomes, optimized cost performance and measurable program value across Medicaid. This executive leverages advanced analytical, data science, and leadership capabilities to optimize medical cost management, drive program performance, and support compliant operations.

This VP will partner with segment leaders and cross-functional teams to develop evidence-based strategies and ensure the delivery of value-based, high-quality care to Medicaid members.

This role sits at the intersection of analytics, program effectiveness, and quality improvement for the Medicaid segment. Functions reporting to this leader include Medical Economics (medical cost analysis, premium analytics, program effectiveness and performance scorecards), Clinical Insights (population health, SDOH, behavioral health, pharmacy strategy, care management strategy), and Quality (withhold management, HEDIS management, value-based payment strategy, audits, and NCQA accreditations). The leader may be a data scientist, financial analyst, economist, or other analytical professional;

though experience in Medicaid or government healthcare programs is essential. The ideal candidate will be a results-oriented, get-stuff-done (GSD) leader who can translate complex analytics into enterprise strategy and execution.

• Lead medical cost analysis, premium analytics, and program effectiveness initiatives for Medicaid products.

• Oversee the creation and tracking of performance scorecards and financial metrics to optimize segment outcomes.

• Collaborate with actuarial, finance, and clinical teams to interpret data and inform executive decisions.

• Direct population health strategy, including analysis of Social Determinants of Health (SDOH) and behavioral health trends.

• Guide pharmacy and care management strategies using data-driven insights to improve member engagement and outcomes.

• Integrate analytical models and predictive tools to inform program design and measurement.

• Oversee quality management, including withhold management, HEDIS performance, Value-Based Payment (VBP) strategy, audits, and NCQA accreditation.

• Ensure compliance with Medicaid requirements and regulatory standards.

• Drive continuous improvement in clinical quality and member satisfaction through robust data analysis.

• Build, mentor, and lead multidisciplinary teams across analytics, economics, and quality functions.

• Foster partnerships with internal stakeholders, regulatory agencies, and external partners to advance clinical effectiveness initiatives.

• Serve as a strategic advisor to the executive team, translating complex analytics into actionable business insights.

• Drive execution excellence, ensuring strategies are implemented effectively and sustainably.

• Embed a culture of accountability, with transparent tracking of program effectiveness and outcomes.

• Deliver actionable insights that directly shape business and clinical operations.

• Bachelor’s Degree/Master’s degree or Ph. D preferred

• 5+ years leadership experience

• 10+ years relevant healthcare analytics or clinical operations, including Medicaid

• Proven track record of integrating medical economics, quality, and clinical insights to drive measurable outcomes.

• Strong grasp of Medicaid policy, quality measurement, population health, and value-based care.

• Demonstrated ability to influence senior leaders and build alignment across diverse functions.

• Decisive, action-oriented leadership style — thrives in complexity and ambiguity, executes with urgency.

• Preferred Locations Humana Hub offices: Louisville KY, Tampa FL, Fort Lauderdale FL, Chicago IL, Washington DC, Arlington VA, Dublin OH, Cincinnati OH, Atlanta GA, Nashville TN, Austin TX, Dallas TX, and Milwaukee WI