Clinical Strategy and Program Development Lead

Job not on LinkedIn

🔥 23 minutes ago

🇺🇸 United States – Remote

💵 $115.2k - $158.4k / year

⏰ Full Time

🟠 Senior

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Identify and evaluate opportunities to improve clinical performance across priority populations and specialties through data analysis, measurement gap assessment, and development of performance frameworks and quality measures • Conduct strategic assessments of clinical performance and measurement gaps to identify improvement opportunities and advance enterprise priorities • Conduct specialty landscape analyses and identify gaps in performance, measurement, and enterprise capabilities to inform future investment decisions • Develop business cases, strategic recommendations, and adoption approaches for new clinical initiatives • Develop and maintain strategic roadmaps that prioritize future clinical performance opportunities and align investments with enterprise objectives • Own and maintain a pipeline of future clinical performance opportunities aligned to enterprise priorities • Develop clinical performance frameworks, quality measures, and measurement strategies to evaluate outcomes and drive improvement • Partner with clinical, analytics, and business leaders to align performance measures with organizational objectives and support meaningful action • Collaborate with cross-functional teams to identify improvement opportunities, establish success metrics, and evaluate results • Support governance processes related to clinical performance measurement and prioritization • Build partnerships across clinical, operational, analytics, network, and business teams • Present recommendations and influence executive decision-making • Lead cross-functional initiatives that improve quality, cost, and member outcomes • Monitor industry trends and emerging best practices • Identify opportunities to expand enterprise clinical capabilities and deliver long-term value

🎯 Requirements

• Bachelor's degree • 8+ years of experience in healthcare strategy, clinical strategy, healthcare consulting, population health, provider performance, value-based care or quality improvement OR 4 years of experience from a top tier consulting • Experience developing strategic recommendations using quantitative and qualitative data analysis • Experience leading cross-functional strategic initiatives and driving results across multiple stakeholders • Experience partnering with analytics teams to analyze healthcare data and generate actionable insights • Experience developing business cases and presenting recommendations to senior leadership • Demonstrated ability to influence without direct authority • Strong executive communication, presentation, and storytelling skills • Self-starter with the ability to proactively identify opportunities, solve complex problems, and manage competing priorities • Demonstrated ability to navigate ambiguity and drive results in a fast-paced environment • Advanced proficiency in Microsoft Excel and PowerPoint • Advanced degree (Master's or Doctorate) in Business (MBA), Public Health, Epidemiology, Healthcare Administration, Clinical Informatics, or a related field • Experience developing business cases, strategic roadmaps, and enterprise-level recommendations for healthcare programs and initiatives • Clinical degree or licensure (e.g., MD, DO, PharmD, APRN, NP, PA, RN, BSN) • Knowledge of healthcare claims data, clinical coding systems and taxonomies (e.g., ICD-10, CPT, HCPCS), quality measurement methodologies, performance analytics, and their application to performance measurement and improvement initiatives • Experience working with Medicare Advantage populations • Experience synthesizing evidence from peer-reviewed literature, industry research, and healthcare trends to support strategic decision-making • Home internet service with minimum 25 Mbps download and 10 Mbps upload • Ability to work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Internet expense payment for employees who live and work from home in California, Illinois, Montana, or South Dakota • Telephone equipment provided for Home or Hybrid Home/Office employees • Remote work arrangement • Occasional travel to Humana offices for training or meetings