Medicaid Lead, Technology Solutions

San Antonio, Texas, United States

Apply with AI Apply

Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Government ProgramsIndustries

Requirements

The Medicaid Lead, Technology Solutions requires a solid understanding of operations, technology, communications, and processes, along with a comprehensive understanding of healthcare operations, particularly claims processing, enrollment, provider data management, and clinical operations, with Medicaid experience being preferred. A deep understanding of a Medicaid Managed Care architecture, tools, utilities, and processes used to deliver core competencies is also necessary.

Responsibilities

The Medicaid Lead, Technology Solutions builds strategic partnerships and manages relationships between IT and business groups, guiding business partners on IT solutions and leveraging industry trends. This role acts as a single point of contact for assigned business areas to IT and represents Humana IT with internal business partners and regulators, contributing to RFP responses and ensuring internal SLAs are in place. The Lead drives organizational-level solutions to align with the IT strategy, engages in market leadership forums, and communicates the enterprise IT strategy to market teams. They advocate for the market's technical needs, lead the translation of contracts into technical requirements, and oversee execution. Additionally, the Lead establishes market-based reporting, tracks compliance and reporting SLAs, balances competing priorities, and proactively manages project concerns with Portfolio and PMO teams.

Skills

Medicaid

Technology Solutions

Strategic Partnerships

Relationship Management

IT Guidance

Industry Trends

Business Acumen

RFP Response

SLA Management

Contractual Obligations

Market Engagement

Communication

Transparency

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.

Land your dream remote job 3x faster with AI

Try Jobo Free