Humana
Overview
Clinical Business Lead role at Humana. Base pay range
$86,300.00/yr - $118,700.00/yr Position Summary
As Regional Clinical Business Lead, you serve as a key member of the regional clinical team responsible for supporting data-driven clinical strategy, performance monitoring, and continuous quality improvement within the Medicare Advantage program to support improving the health of members. The Clinical Business Lead collaborates with regional leadership and cross-functional teams to ensure alignment with initiatives to drive improved member health outcomes. This role works with the Regional Vice President of Health Services (RVP) and Health Services Director (HSD) to enable connections with physicians and providers, support innovation initiatives, implement clinical programs, vet new vendor programs, and ensure performance management. Primary Responsibilities
Data Analytics to Support Clinical Strategy, Performance Reporting, and Monitoring Analyze chronic condition performance to provide insights to provider groups to drive awareness, education and action plans Evaluate the effectiveness of clinical program initiatives by analyzing the downstream impact on facility and provider performance in value-based programs Identify opportunities for new clinical program initiatives by assessing cost and utilization drivers, including chronic condition focus Prepare data and evaluate performance to support governance and delegation oversight; interact with corporate delegation compliance and auditing teams Project Management And Activity Tracking Oversee planning, execution, and closing of clinical projects to meet objectives within timelines and budget Develop and maintain detailed project plans and resource allocation schedules Monitor project progress, identify risks, and implement mitigation strategies Manage project documentation, reporting, and stakeholder communication Evaluate project outcomes, perform data analysis, and present findings to leadership Collaborate with cross-functional teams to promote best practices and process improvements Ensure alignment with national and local clinical program requirements and standards Vendor/Pilot Program Evaluation And Monitoring Assist in evaluating clinical program pilots and vendor-supported initiatives through analysis and monitoring of key performance indicators Review delegation team audits and supplement with regular reviews to ensure vendor programs comply with regulatory standards and internal policies Provide insights to inform program scalability and effectiveness Required Qualifications
Bachelor’s degree in a health-related field (Nursing, Public Health, Epidemiology, etc.) Minimum of 5 years of relevant experience Minimum 3 years of experience in data analytics, quality, project management or process improvement Proficient in analyzing data from various tools and creating actionable insights (Excel, Tableau, Power BI, databricks) Strong understanding of value-based care, population health, and clinical quality metrics Excellent organizational, communication, and problem-solving skills Proven ability to provide high-quality, responsive service to internal and external stakeholders Demonstrated ability to lead through influence and collaborate across teams Thrive in a remote work environment with independent work skills Travel expected 5-15% Preferred Qualifications
Advanced Degree (MSN, MBA, MHA, MPH) Experience in managed care, health plan operations, or Medicare Advantage programs Project management experience or certification (e.g., PMP, Lean Six Sigma) Work-At-Home Requirements
Minimum download speed 25 Mbps and upload speed 10 Mbps; wired/wireless connections acceptable Satellite, cellular, and microwave connections require leadership approval Work from Home in California, Illinois, Montana, or South Dakota may receive bi-weekly internet expense payment Humana will provide appropriate telephone equipment to meet business requirements Work from a dedicated space to protect member PHI / HIPAA information Additional Information
Standard Business Hours: Monday-Friday; Pacific, Mountain, or Central time zone. Travel to Humana offices for training or meetings may be required. Scheduled Weekly Hours: 40 Benefits
Humana offers medical, dental, vision, 401(k), paid time off, holidays, volunteer time off, parental and caregiver leave, disability, life insurance, and other opportunities. About
Humana, Inc. (NYSE: HUM) is committed to putting health first and serving teammates, customers, and the community. Equal Opportunity Employer
Humana does not discriminate and is an equal opportunity employer. We comply with applicable laws and regulations and are committed to affirmative action.
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Clinical Business Lead role at Humana. Base pay range
$86,300.00/yr - $118,700.00/yr Position Summary
As Regional Clinical Business Lead, you serve as a key member of the regional clinical team responsible for supporting data-driven clinical strategy, performance monitoring, and continuous quality improvement within the Medicare Advantage program to support improving the health of members. The Clinical Business Lead collaborates with regional leadership and cross-functional teams to ensure alignment with initiatives to drive improved member health outcomes. This role works with the Regional Vice President of Health Services (RVP) and Health Services Director (HSD) to enable connections with physicians and providers, support innovation initiatives, implement clinical programs, vet new vendor programs, and ensure performance management. Primary Responsibilities
Data Analytics to Support Clinical Strategy, Performance Reporting, and Monitoring Analyze chronic condition performance to provide insights to provider groups to drive awareness, education and action plans Evaluate the effectiveness of clinical program initiatives by analyzing the downstream impact on facility and provider performance in value-based programs Identify opportunities for new clinical program initiatives by assessing cost and utilization drivers, including chronic condition focus Prepare data and evaluate performance to support governance and delegation oversight; interact with corporate delegation compliance and auditing teams Project Management And Activity Tracking Oversee planning, execution, and closing of clinical projects to meet objectives within timelines and budget Develop and maintain detailed project plans and resource allocation schedules Monitor project progress, identify risks, and implement mitigation strategies Manage project documentation, reporting, and stakeholder communication Evaluate project outcomes, perform data analysis, and present findings to leadership Collaborate with cross-functional teams to promote best practices and process improvements Ensure alignment with national and local clinical program requirements and standards Vendor/Pilot Program Evaluation And Monitoring Assist in evaluating clinical program pilots and vendor-supported initiatives through analysis and monitoring of key performance indicators Review delegation team audits and supplement with regular reviews to ensure vendor programs comply with regulatory standards and internal policies Provide insights to inform program scalability and effectiveness Required Qualifications
Bachelor’s degree in a health-related field (Nursing, Public Health, Epidemiology, etc.) Minimum of 5 years of relevant experience Minimum 3 years of experience in data analytics, quality, project management or process improvement Proficient in analyzing data from various tools and creating actionable insights (Excel, Tableau, Power BI, databricks) Strong understanding of value-based care, population health, and clinical quality metrics Excellent organizational, communication, and problem-solving skills Proven ability to provide high-quality, responsive service to internal and external stakeholders Demonstrated ability to lead through influence and collaborate across teams Thrive in a remote work environment with independent work skills Travel expected 5-15% Preferred Qualifications
Advanced Degree (MSN, MBA, MHA, MPH) Experience in managed care, health plan operations, or Medicare Advantage programs Project management experience or certification (e.g., PMP, Lean Six Sigma) Work-At-Home Requirements
Minimum download speed 25 Mbps and upload speed 10 Mbps; wired/wireless connections acceptable Satellite, cellular, and microwave connections require leadership approval Work from Home in California, Illinois, Montana, or South Dakota may receive bi-weekly internet expense payment Humana will provide appropriate telephone equipment to meet business requirements Work from a dedicated space to protect member PHI / HIPAA information Additional Information
Standard Business Hours: Monday-Friday; Pacific, Mountain, or Central time zone. Travel to Humana offices for training or meetings may be required. Scheduled Weekly Hours: 40 Benefits
Humana offers medical, dental, vision, 401(k), paid time off, holidays, volunteer time off, parental and caregiver leave, disability, life insurance, and other opportunities. About
Humana, Inc. (NYSE: HUM) is committed to putting health first and serving teammates, customers, and the community. Equal Opportunity Employer
Humana does not discriminate and is an equal opportunity employer. We comply with applicable laws and regulations and are committed to affirmative action.
#J-18808-Ljbffr