Principal Consultant, Medicaid Medical Economics, Cost Management

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $142.3k - $195.7k / year

⏰ Full Time

🔴 Lead

💼 Consultant

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ 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

• Lead and track specific clinical, BH, and Rx cost management initiatives across the Medicaid portfolio. • Synthesize cost, utilization, and outcomes data to drive strategic decision-making, ensure initiative execution, and supports enterprise-wide cost management and medical economics strategies. • Project manage best practices to drive execution, measure progress, and ensure timely delivery. • Develop, represent, and integrate a medical cost management plan into annual and multi-year business plans. • Collaborate with leaders across Clinical, Pharmacy, Network, Product, and Claims teams. • Act as the primary business partner to Finance, translating clinical and operational insights into actionable financial impact. • Analyze historical, predicted, and competitive market data to recommend benchmarks and KPIs. • Research industry standards, vendor solutions, and build requirements for internal solutions. • Lead as business accountability champion for quarterly reviews with Trend Stewardship Committee.

🎯 Requirements

• Bachelor’s degree in Economics, Statistics, Public Health, Healthcare Administration, or related field. • 10+ years of healthcare industry experience (payer, medical economics, analytics, cost management, or related). • Demonstrated experience leading cross-functional teams and executing complex, large-scale transformation initiatives. • Advanced analytic acumen; proficiency in Excel and data visualization tools. • Strong understanding of healthcare reimbursement models, managed care, and principles of medical cost management. • Proven organizational, planning, and prioritization skills. • Highly collaborative mindset, with excellent stakeholder engagement and executive-level communication skills. • Ability to synthesize data into actionable business insights and drive measurable improvements.

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance • many other opportunities