Lead-Medicaid Customer Success

About the Role

Employment Type: Full time

Become a part of our caring community and help us put health first. The Lead - Medicaid Customer Success oversees strategy and operations for multiple Medicaid markets. This role is responsible to ensure compliance with client contracts, as well as to identify opportunities and implement program improvements to enhance our member and customer experience.

Key Responsibilities

• Partner with market, government affairs teams, sales teams to define overall strategy for each Medicaid state
• Work with market partners to perform cost / benefit analysis of potential projects
• Manage client relationship
• Monitor proposed regulatory changes to Medicaid and provide strategic recommendations to government affairs teams
• Create strong partnerships with internal team members
• Identify opportunities to improve member experience and / or profitability and manage the product life cycle from inception to implementation
• Collaborate with business owners to streamline issue management and resolution
• Monitor plan performance and proactively bring issues to the forefront for review
• Support new business implementations with a goal of ensuring all pharmacy claims are processing appropriately
• Drive project development and support project management for all product improvement initiatives
• Create monthly business reviews and present to client
• Escalate issues for immediate review and action whenever necessary
• Request, review and approve data used for prioritization purposes
• Analyze data related to pharmacy trends and collaborating with internal partners and the Medicaid market to manage pharmacy utilization and spend
• Manage escalated member, client and / or pharmacy issues and resolve in the Medicaid market, follow through on issues to determine if they can be impacting all other markets
• Review all requests from the standpoint of how can we make the experience better for our members, clients and partners, seek to understand the ideal impact, strive for continuous improvements.

Use your skills to make an impact.

Required Qualifications

• 3 - 5 years' experience with PBM operations
• 3 - 5 years managing large scale projects and cross functional teams
• Success in developing working relationships within a highly matrixed business environment
• Ability to analyze data and make informed recommendations
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Bachelor's degree
• Experience responding to state and/or federal government solicitations
• Experience developing relationships with key stakeholders to understand and improve the market

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work at home requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

SSN Alert: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email...