Program Delivery Lead

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $115.2k - $158.4k / year

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

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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

• Lead strategy, implementation, and operational execution of Medicaid Revenue Optimization and Member Activation programs • Partner with Finance, Market Operations, Risk Adjustment, Care Management, Encounters, Compliance, Market Leadership, Product, and external vendors • Lead Medicaid revenue optimization initiatives including SSI eligibility identification and conversions, ESRD Medicare and non-dual to dual transitions, member activation and engagement, and condition-based solutions • Develop and execute multi-year program roadmaps aligned with organizational growth objectives • Identify opportunities to improve program performance, financial outcomes, member engagement, and member experience • Monitor leading and lagging indicators to proactively manage business performance • Oversee end-to-end program delivery from strategy through implementation and ongoing operations • Establish operational frameworks, governance structures, KPI reporting, and performance management processes • Remove barriers affecting outreach effectiveness, encounter acceptance, provider documentation, and vendor execution • Ensure program scalability across multiple Medicaid markets • Build partnerships across Finance, Clinical and Care Management, Compliance, Procurement, Member and Provider Engagement, Encounters Operations, Medicaid Market Leadership, and Actuarial • Facilitate executive-level discussions about performance, opportunities, and risk mitigation • Drive stakeholder accountability to meet program objectives • Lead strategic vendor relationships supporting member engagement and revenue optimization • Establish performance standards and monitor contractual outcomes • Evaluate vendor capacity, quality, operational efficiency, and financial value realization • Partner with vendors to improve member activation and program completion rates • Quantify business opportunities and expected financial outcomes • Develop business cases and ROI analyses for program enhancements and market expansions • Monitor revenue realization, cost structures, forecast performance, and financial risks • Present performance updates and recommendations to executive leadership • Support introduction of programs into new Medicaid markets • Navigate state-specific regulatory requirements and approval processes • Evaluate emerging revenue optimization opportunities and new member engagement strategies • Drive continuous improvement, innovation, organizational change, and adoption across matrixed teams

🎯 Requirements

• Bachelor's degree • 5+ years within Medicaid, Medicare, managed care, revenue optimization, risk adjustment, care management, or health plan operations • 5 or more years of technical experience • 2 or more years of project leadership experience • Strong knowledge of Microsoft Office XP products (Word, Excel, Access) • Excellent oral and written communication skills • Strong relationship-building skills • Passion for contributing to an organization focused on continuously improving consumer experiences • Experience leading enterprise-scale, cross-functional initiatives • Experience with vendor management and performance governance • Strong financial and analytical capabilities • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Home internet service with at least 25 Mbps download and 10 Mbps upload speeds • Master's Degree in Business Administration or related field (preferred) • PMP certification (preferred) • Six Sigma Certification (preferred) • Knowledge and experience in healthcare environment/managed care (preferred) • Technical skills such as Power BI, Databricks, and SQL (preferred)

🏖️ 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 • Personal wellness and smart healthcare decision support • Remote work arrangement • Occasional travel to Humana offices for training or meetings