VP, Operations Cost of Care

Become a part of our caring community and help us put health first

The current industry landscape presents challenges and the need for increased focus on new strategies to drive reduced medical costs. The need has emerged within Clinical Operations to re-purpose an existing leadership role and reorganize functions to create a designated function and leader for Utilization Management (UM) and Care Management (CM) cost of care strategies, to drive focus and accountability to identify, coordinate, drive and deliver strategies and initiatives related to curbing medical cost.

This position is remote US. However not in Hawaii, Alaska or Puerto Rico

This role will report to the SVP Clinical Operations

Responsibilities:

This role will provide executive leadership for Medicare UM-CM cost of care strategies, as the primary accountable leader for Clinical Operations target achievement

+ Ownership to develop and deliver trend strategy, pipeline, and goal achievement for Clinical Operations.

+ This role will need to operate across all functions within Clinical Operations (UM, CM, Shared Services team), as well directly partner to coordinate with key leadership partners in other organizations such as Clinical Strategy, HQRI , Market Clinical Teams, etc. to align opportunities and goal achievement.

+ Lead enterprise efforts to synthesize medical cost trends for UM – CM related operational activities and delivery.

+ Develop strategic plans to address identified opportunities, including evaluating industry standards, partnering to drive vendor strategies and stand-up internal solutions.

+ Partner with TAF , Finance, Actuarial, and various Clinical teams (may include Pharmacy, Network, Product and Claims) to deliver the UM focused solutions.

+ Leverage historical data and insights to establish KPIs and benchmarks for delivering results.

+ This role and team will be the UM expert regarding medical expense analysis and sizing of proposed medical policy changes and other cost savings initiatives.

+ Work with a range of teams to analyze relevant data, determine cost savings opportunities and remove roadblocks for implementation.

+ Oversees operations and vendor management for UM delegate partners

+ Develops strategic partnerships with vendors to accelerate innovation and ensure best possible member health outcomes.

+ This position will have critical oversight of Cohere, one of Humana’s key strategic vendor partnerships

+ Personal Attributes : Ability to operate across functions within the segment, highly collaborative, clinical knowledge and expertise, business and financial acumen, strong leadership and executive presence

Use your skills to make an impact

Required Qualifications

+ Bachelor’s degree in Business, Healthcare Administration, or related field

+ 10 or more years in health plan policy, strategy, or operations

+ Deep clinical strategy, knowledge, and expertise

+ 8 or more years of leadership experience

+ Track record of delivering results through transformational change

+ Demonstrated experience enabling a strong culture of associate experience

+ Strong business and financial acumen

Preferred Qualifications

+ P&L experience

+ Master’s degree in related field

Additional Information

+ Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from with instructions on how to add the information into your official application on Humana’s secure website.

+ To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggestedSatellite, cellular and microwave connection can be used only if approved by leadershipEmployees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

+ Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:Health benefits effective day 1Paid time off, holidays, volunteer time and jury duty payRecognition pay401(k) retirement savings plan with employer matchTuition assistanceScholarships for eligible dependentsParental and caregiver leaveEmployee charity matching programNetwork Resource Groups (NRGs)Career development opportunities

Scheduled Weekly Hours

40

About us

Humana Inc. ( NYSE : HUM ) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

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 because he or she is a protected veteran. It is also the policy of ?Humana?to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our