Associate VP, Clinical Strategy and Practice

at Humana in Dover, Delaware, United States

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

The Associate VP, Clinical Strategy and Practice builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise. The Associate VP, Clinical Strategy and Practice requires an in-depth understanding of how organization capabilities interrelate across the segments and/or enterprise-wide.

The Associate VP, Clinical Strategy and Practice decisions are typically related to intradepartmental coordination, development and implementation of strategic plans, and business outcomes, and develops and implements strategic plans for the scope of management that are aligned with the Segment or Business strategy.

Use your skills to make an impact

Humana is a $90 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.

Against that backdrop, we are seeking a strategic-thinking leader for the role of Associate VP, Health Services. In this role, you will build strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise. You will be accountable to deliver several meaningful bodies of work that will have long term impact for our members and the future success of the Medicaid Programs as we expand our Medicaid presence in new markets.

The AVP reports to the Vice President/Chief Medical Officer – Medicaid and will lead a multi-level organization of 175-200 associates. We are open as to the location for this position, although the eastern half of the U.S. is strongly preferred. Travel of as much as 25% should be expected as business needs dictate.

Key Responsibilities

The core responsibilities of the AVP position revolve around three main areas:

+ To build models to centralize several UM clinical functions and transition plans that maintain quality of care and execution to move to centralized models. This change will result in Utilization Management consistency and significant cost efficiencies that will save 15% – 30% in cost savings annually state by state.

+ To build and implement a consistent clinical operating model for all Medicaid Programs. This work will provide the organization with a consistent approach to care management and drive human care as a central theme in our approach. This consistency will allow us to best manage talent across programs, write to consistent clinical programs for business development, drive best practice and operational efficiencies to each program and ease the demand on implementation teams.

+ To be a voice of Medicaid across the entire Humana enterprise. This leader will create business strategies to ensure we manage any migration activity and align to new processes and systems, while maintaining our clinical effectiveness.

From a functional perspective, the AVP will ensure success in the following areas for all of Medicaid either through direct oversight, direct participation or close collaboration with Medicaid and enterprise partners:

+ Clinical Service Operations

+ Welcome Calls / HRAs (Health Risk Assessments)

+ Centralized UM for physical health and behavioral health

+ Clinical Experience Oversight

+ PAL Governance (Prior Authorization List)

+ G&A Clinical Reviews

+ Clinical Training & Process Support

+ Operational Strategy Development

+ Care Model Integration, including integration of Physical, Behavioral and Social Determinants of Health as well as greater integration between Medicaid and Medicare for D- SNP populations

+ Quality Strategy

+ Behavioral Health

+ Care Management

+ Pharmacy

+ Women’s health

+ Centralized Reviewing Medical Directors

+ Quality teams

+ Analytics teams

Key Candidate Qualifications

The successful candidate will have deep experience (typically 7+ years) in clinical leadership, along with extensive experience (typically 5+ years) in Managed Care Operations leadership. This person will have broad subject matter expertise spanning both Medicaid and Medicare and will also be a proven leader of people with a record of success in expanding and elevating the capabilities and performance of the team. Bachelor’s degree is required, preferably in a Clinical, Social Work, or Behavioral Health field, although a Master’s degree is a strong preference.

In addition to the above, the following technical qualifications and personal attributes are also sought:

+ RN or LCSW licensure

+ Experience developing collaborative partnerships with enterprise cross-functional teams

+ Experience leading large organizational implementations and/or centralized services teams

+ Current or recent experience in a large, highly matrixed company (i.e., Fortune 250), with proven ability to influence leaders and key stakeholders in such an environment

+ Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences

+ Exceptional consultative skills that combine a highly collaborative mindset with the ability to stand firm in the face of resistance from diverse stakeholders and SMEs, and win their co-ownership in the outcomes

+ Demonstrated ability to manage large scale initiatives and drive them to completion working with cross-functional/enterprise teams

+ Demonstrated ability to toggle effortlessly between strategic and tactical activities

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$181,200 – $249,300 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, ‘Humana’) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

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, ge