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Clinical Business Lead
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Humana Clinical Business Lead, Humana Medicare Advantage 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. Primary Responsibilities
Analyze chronic condition performance so regional clinical leadership can bring insights to provider groups to drive awareness, education and action plans. Evaluate the effectiveness of clinical program initiatives through analysis of the downstream impact of such initiatives on facility and provider performance in value-based programs. Identify opportunities for new clinical program initiatives by assessing cost and utilization drivers, inclusive of a chronic condition focus. Prepare data and evaluate performance to support RVP and HSD in governance and delegation oversight committee and interact with the corporate delegation compliance and auditing teams. Project Management And Activity Tracking
Oversee the planning, execution, and closing of clinical projects to ensure objectives are met within required 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 communication with stakeholders 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 Compliance and Quality Improvement: Participate in continuous quality improvement initiatives, including root cause analysis, best practices to close care gaps. Vendor/Pilot Program Evaluation And Monitoring
Assist in the evaluation of clinical program pilots and vendor supported initiatives through analysis and monitoring of key performance indicators. Review the delegation team audits and, if needed, supplement them 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 (such as MSN, MBA, MHA, MPH). Experience in managed care, health plan operations, or Medicare Advantage programs (including various SNP products) or Managed Medicaid. Project management experience or certification (e.g., PMP, Lean Six Sigma). Work-At-Home Requirements
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Associates 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 associates 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 Additional Information
Standard Business Hours: Monday-Friday; Pacific, Mountain, or Central time zone Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours: 40 Pay Range: $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. 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. 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 protected veteran status.
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Clinical Business Lead
role at
Humana Clinical Business Lead, Humana Medicare Advantage 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. Primary Responsibilities
Analyze chronic condition performance so regional clinical leadership can bring insights to provider groups to drive awareness, education and action plans. Evaluate the effectiveness of clinical program initiatives through analysis of the downstream impact of such initiatives on facility and provider performance in value-based programs. Identify opportunities for new clinical program initiatives by assessing cost and utilization drivers, inclusive of a chronic condition focus. Prepare data and evaluate performance to support RVP and HSD in governance and delegation oversight committee and interact with the corporate delegation compliance and auditing teams. Project Management And Activity Tracking
Oversee the planning, execution, and closing of clinical projects to ensure objectives are met within required 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 communication with stakeholders 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 Compliance and Quality Improvement: Participate in continuous quality improvement initiatives, including root cause analysis, best practices to close care gaps. Vendor/Pilot Program Evaluation And Monitoring
Assist in the evaluation of clinical program pilots and vendor supported initiatives through analysis and monitoring of key performance indicators. Review the delegation team audits and, if needed, supplement them 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 (such as MSN, MBA, MHA, MPH). Experience in managed care, health plan operations, or Medicare Advantage programs (including various SNP products) or Managed Medicaid. Project management experience or certification (e.g., PMP, Lean Six Sigma). Work-At-Home Requirements
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Associates 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 associates 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 Additional Information
Standard Business Hours: Monday-Friday; Pacific, Mountain, or Central time zone Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours: 40 Pay Range: $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. 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. 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 protected veteran status.
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