Clinical Strategy Lead

San Antonio, Texas, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a Bachelor's degree and have 7 or more years of experience in healthcare, payor, provider, and/or consulting. Strategy experience, including the use of quantitative and qualitative data to build strategic recommendations, is essential. A passion for improving health outcomes, particularly for seniors, and a driven, collaborative, and curious mindset are also required.

Responsibilities

The Clinical Strategy Lead will drive strategies to ensure members access the highest quality providers and improve the quality of care offered. This involves analyzing complex clinical and business issues, leading quantitative and qualitative analysis, and identifying data insights to inform strategy. Responsibilities include partnering with clinicians, data scientists, actuaries, and business owners to develop and present strategy recommendations to senior leadership, synthesizing clinical literature and external research, developing learning agendas and test plans, and building business cases for identified problems.

Skills

Clinical Strategy

Data Analysis

Healthcare Data

Operational Data

Quantitative Analysis

Qualitative Analysis

Cross-functional Collaboration

Leadership

Problem-Solving

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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