Medicaid Lead, Technology Solutions

Employment Type: Full time

Position Overview

Become a part of our caring community and help us put health first. The Medicaid Lead, Technology Solutions builds strategic partnerships and manages relationships between IT and the aligned business group(s). The Lead facilitates guidance to business partners on information technology (IT) solutions, stays current on and leverages industry trends, and challenges business and IT to drive for best outcomes by leveraging the best technology solutions. This is achieved by having a clear understanding of business, its strategic direction, and targeted outcomes along with technology trends both internal and external to the organization. The role serves as the Single Point of Contact representing assigned business area(s) to the IT organization and representing Humana IT with internal business partners along with State and Federal regulators. The Lead contributes to RFP responses to ensure they are accurate and reflect the true and competitive capabilities Humana brings to the table, ensures internal SLAs are in place to support contracts and technology is configured to operate within contractual obligations. The Lead drives solutions at an organizational level to provide maximum value and align to the overarching IT strategy.

This State Technology Lead role will cover the Michigan Medicaid/DSNP product lines along with one additional state.

Responsibilities

Market Engagement and Presence

• Active Participation: Engage actively in market leadership forums to stay connected with market needs and dynamics.
• Deep Understanding: Develop a thorough understanding of market contract requirements and maintain regular communication with market leadership to ensure alignment and responsiveness.
• Communication and Transparency:
  • Enhanced Communication: Improve communication and transparency with market teams by clearly articulating the enterprise IT strategy and its impact on the markets. Improve the understanding of Market needs within IT and ultimately the quality of delivery by representing the Market in IT forums.
  • Regular Meetings: Hold regular meetings to discuss IT priorities, new requests, and collaborate with Market Operations and Compliance teams. Facilitate and communicate with state agencies on outages, impacts, and mitigation planning.

Advocacy and Leadership

• Market Advocacy: Advocate for the market's technical needs and assist in navigating approvals and prioritizations in partnership with the market COO.
• Execution Leadership: Lead the translation of contracts into internal technical requirements and oversee the execution process from start to finish, ensuring all stakeholders are aligned and informed, including new functionality needs, data connections, adaption to changing state regulations and the like.

Reporting and Metrics

• Consistent Reporting: Establish a consistent reporting cadence and template for market-based reporting to ensure clarity and accountability.
• Compliance and Reporting Tracking: Track market compliance and reporting SLAs to drive performance, identify areas for improvement, and ensure alignment with market goals.

Operational Focus and Proactivity

• Priority Management: Balance competing priorities by reducing or adjusting, in partnership with the market COO, the number of simultaneous initiatives to focus on the most critical projects.
• Proactive Issue Management: Partner with the Portfolio and PMO teams to address project concerns proactively and create mitigation plans for potential impacts, ensuring timely delivery of needed capabilities.

Use your skills to make an impact.

Required Qualifications

• Solid understanding of operations, technology, communications, and processes.
• Solid understanding of healthcare operations, particularly around claims processing, enrollment, provider data management and clinical operations; Medicaid preferred.
• Comprehensive understanding of a Medicaid Managed Care architecture, tools, utilities and processes utilized to deliver on core competences.

Salary

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Location Type

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