[Remote] Clinical Business Lead at Humana

Washington, District of Columbia, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

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 (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
Travel expected 5-15%
Advanced Degree (such as MSN, MBA, MHA, MPH) preferred

Responsibilities

Data Analytics to Support Clinical Strategy, Performance Reporting, and Monitoring
Evaluate the effectiveness of clinical program initiatives
Identify opportunities for new clinical program initiatives
Prepare data and evaluate performance to support RVP and HSD in governance and delegation oversight committee
Project management and activity tracking
Collaborate with cross-functional teams to promote best practices and process improvements
Ensure alignment with national and local clinical program requirements and standards
Vendor/Pilot Program Evaluation and Monitoring
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

Skills

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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