Humana
Overview
Join to apply for the
Clinical Business Lead
role at
Humana . 2 days ago Be among the first 25 applicants. This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range
$86,300.00/yr - $118,700.00/yr Position summary
Become a part of our caring community and help us put health first. The Clinical Business Lead, Humana Medicare Advantage, serves as a key member of the regional clinical team responsible for data-driven clinical strategy, performance monitoring, and continuous quality improvement within the Medicare Advantage program to support improving the health of members. This role requires close collaboration with regional leadership and cross-functional teams to ensure alignment with initiatives that drive improved member health outcomes. The Clinical Business Lead works with the Regional VP 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. Responsibilities
Data analytics to support clinical strategy, performance reporting, and monitoring: analyze chronic condition performance to inform provider groups and drive awareness, education, and action plans; evaluate the effectiveness of clinical program initiatives on facility and provider performance in value-based programs; identify opportunities for new clinical program initiatives by assessing cost and utilization drivers (including chronic conditions); prepare data and evaluate performance to support RVP and HSD in governance and delegation oversight, and interact with corporate delegation compliance and auditing teams. Project management and activity tracking: oversee planning, execution, and closing of clinical projects within timelines and budget; develop and maintain detailed project plans and resource allocation; monitor progress, identify risks, and implement mitigation; manage documentation, reporting, and stakeholder communications; evaluate 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; participate in continuous quality improvement initiatives, including root cause analysis and closing care gaps. Vendor/pilot program evaluation and monitoring: assist in evaluating clinical program pilots and vendor-supported initiatives through analysis 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. Thrives in a remote work environment with independent work skills. Travel expected 5-15%. Preferred Qualifications
Advanced Degree (e.g., MSN, MBA, MHA, MPH). Experience in managed care, health plan operations, or Medicare Advantage programs (including SNP products) or Managed Medicaid. Project management experience or certification (e.g., PMP, Lean Six Sigma). Work-At-Home Requirements
Internet service must meet minimum criteria for home or hybrid work; recommended speeds: 25 Mbps download, 10 Mbps upload. Satellite, cellular, and microwave connections require leadership approval. In some states (CA, IL, MT, SD), bi-weekly internet expense payments may be provided. Humana provides appropriate telephone equipment to meet business requirements. Work from a dedicated space free from ongoing interruptions to protect member PHI/HIPAA information. Additional Information
Standard Business Hours: Monday-Friday; Pacific, Mountain, or Central time zone. Travel: occasional travel to Humana offices for training or meetings may be required. Scheduled Weekly Hours: 40 Pay Range: The compensation range below reflects a good faith estimate of starting base pay for full-time employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, etc. $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description Of Benefits
Humana offers competitive benefits to support whole-person well-being, including medical, dental and vision benefits, 401(k) retirement savings, paid time off (including holidays, volunteer time off, parental and caregiver leave), disability and life insurance, and other benefits. Application Deadline: 10-14-2025 About Us
Humana Inc. (NYSE: HUM) is committed to putting health first for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, Humana aims to help people achieve their best health. Equal Opportunity Employer
Humana does not 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 protected veteran status. Humana complies with Section 503 of the Rehabilitation Act and VEVRAA to employ and advance individuals with disabilities or protected veteran status, based on valid job requirements.
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Join to apply for the
Clinical Business Lead
role at
Humana . 2 days ago Be among the first 25 applicants. This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range
$86,300.00/yr - $118,700.00/yr Position summary
Become a part of our caring community and help us put health first. The Clinical Business Lead, Humana Medicare Advantage, serves as a key member of the regional clinical team responsible for data-driven clinical strategy, performance monitoring, and continuous quality improvement within the Medicare Advantage program to support improving the health of members. This role requires close collaboration with regional leadership and cross-functional teams to ensure alignment with initiatives that drive improved member health outcomes. The Clinical Business Lead works with the Regional VP 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. Responsibilities
Data analytics to support clinical strategy, performance reporting, and monitoring: analyze chronic condition performance to inform provider groups and drive awareness, education, and action plans; evaluate the effectiveness of clinical program initiatives on facility and provider performance in value-based programs; identify opportunities for new clinical program initiatives by assessing cost and utilization drivers (including chronic conditions); prepare data and evaluate performance to support RVP and HSD in governance and delegation oversight, and interact with corporate delegation compliance and auditing teams. Project management and activity tracking: oversee planning, execution, and closing of clinical projects within timelines and budget; develop and maintain detailed project plans and resource allocation; monitor progress, identify risks, and implement mitigation; manage documentation, reporting, and stakeholder communications; evaluate 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; participate in continuous quality improvement initiatives, including root cause analysis and closing care gaps. Vendor/pilot program evaluation and monitoring: assist in evaluating clinical program pilots and vendor-supported initiatives through analysis 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. Thrives in a remote work environment with independent work skills. Travel expected 5-15%. Preferred Qualifications
Advanced Degree (e.g., MSN, MBA, MHA, MPH). Experience in managed care, health plan operations, or Medicare Advantage programs (including SNP products) or Managed Medicaid. Project management experience or certification (e.g., PMP, Lean Six Sigma). Work-At-Home Requirements
Internet service must meet minimum criteria for home or hybrid work; recommended speeds: 25 Mbps download, 10 Mbps upload. Satellite, cellular, and microwave connections require leadership approval. In some states (CA, IL, MT, SD), bi-weekly internet expense payments may be provided. Humana provides appropriate telephone equipment to meet business requirements. Work from a dedicated space free from ongoing interruptions to protect member PHI/HIPAA information. Additional Information
Standard Business Hours: Monday-Friday; Pacific, Mountain, or Central time zone. Travel: occasional travel to Humana offices for training or meetings may be required. Scheduled Weekly Hours: 40 Pay Range: The compensation range below reflects a good faith estimate of starting base pay for full-time employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, etc. $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description Of Benefits
Humana offers competitive benefits to support whole-person well-being, including medical, dental and vision benefits, 401(k) retirement savings, paid time off (including holidays, volunteer time off, parental and caregiver leave), disability and life insurance, and other benefits. Application Deadline: 10-14-2025 About Us
Humana Inc. (NYSE: HUM) is committed to putting health first for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, Humana aims to help people achieve their best health. Equal Opportunity Employer
Humana does not 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 protected veteran status. Humana complies with Section 503 of the Rehabilitation Act and VEVRAA to employ and advance individuals with disabilities or protected veteran status, based on valid job requirements.
#J-18808-Ljbffr