Job description
The Clinical Strategy and Analytics team is focused on improving the value of the care we provide by ensuring appropriate utilization of healthcare services while improving health outcomes and member experience. This position requires a broad understanding of the mechanisms available to health plans to impact value and improve health outcomes, and how organization capabilities interrelate across the functions or segments.
Responsibilities
Location: work at home anywhere
Job Description
The Clinical Strategy and Analytics Lead provides data-based strategic direction to identify and address business issues and opportunities. Supports enterprise-wide initiative to address healthcare waste and low value care to positively impact medical costs, improve the member experience, and enhance health outcomes. Leads initiatives to evaluate complex business problems and issues using advanced analytic techniques, and clinical acumen to identify actionable clinical opportunities. Guides strategy to study and identify trend and savings opportunities related to specific functional areas which may include utilization management, pharmacy, value-based contracting, networks, etc. Collaborates with multi-disciplinary teams across the organization including: operational owners to translate strategic recommendations to implementation-ready plans, while also working with actuaries to value the financial impact of the plans. Strong leadership through influence will be required to deeply integrate with the partner organizations and understand their business capabilities and barriers to execute on identified strategies.
Responsibilities include:
Engage in an ambiguous problem solving and strategy settingUse data, analytics, and industry subject matter expertise to identify opportunities to improve clinical outcomes, quality, cost, and experience for members/providers
Develop analytics protocols to identify actionable insights
Lead cross-functional teams to define discrete opportunities that are both impactful and achievable
Work directly with partners across the enterprise to create the roadmap to capture prioritized opportunities
Collaborate with a variety of partners to identify levers to address identified medical cost opportunities
Collaborate with clinicians and actuaries to forecast financial impact of initiatives
Produce high quality presentations and reports to be shared with senior leadership
Role Essentials
Advanced degree (masters or doctorate) in business (MBA), public health, epidemiology, healthcare, clinical informatics or related field Clinical degree (MD, DO, PharmD, APRN, PA, NP, BSN, RN)
6 or more years of payer and/or consulting experience in the healthcare industry
3+ years of experience in strategic business role with a payer or consulting role or similar
3+ years of experience in guiding analytics/studies and analyzing data to generate insights
Knowledge of healthcare data
Demonstrated ability to define and lead large cross-organizational initiatives
Demonstrated ability to anticipate and be proactive around next steps within large initiatives simultaneously
Demonstrated ability to lead through ambiguity and function independently
Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
High learning acuity and ability to navigate rapidly changing situations and business priorities
Role Desirables
Experience working multi-disciplinary teams (e.g., actuaries, statisticians, operational leaders and clinicians), with evidence of deep understanding of healthcare data and health-systems operations
Experience with healthcare claims data sets
Prior healthcare management consulting or project lead experience with large US-based consulting firm
Critical literature evaluation experience
Health care cost/utilization experience, clinical coding, healthcare services, health economics or policy research experience
Knowledge of utilization, care, and/or claims cost management processes (prior authorization, provider payment integrity, audit, waste and abuse, clinical interventions etc)
Experience with medical cost opportunity and gaps in care identification
Additional Information
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire.
WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Scheduled Weekly Hours
40Not Specified
0
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