[Remote] Medicaid State Technology Lead at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor’s degree in healthcare administration, public health, information systems, business, policy administration or related field (work experience may meet this need)
5+ years managed care experience
5+ years in Medicaid program implementation or healthcare operations, with demonstrated leadership of complex, multi-disciplinary projects
Solid understanding of payor operations, technology, communications, and processes
Solid understanding of healthcare operations, particularly around claims processing, enrollment, provider data management and clinical operations; Medicaid preferred

Responsibilities

Oversee testing for 1-2 states and their associated product lines in parallel, then roll on to the next state program(s)
Understand priorities of all delivery for assigned state and support business goals of the Medicaid IT program
Identify and implement best practice changes within organization and across Medicaid IT to drive faster and more streamlined delivery cycles
Coordinate resolution of major initiatives deliverables requiring urgent attention/escalation
Guide state and market implementations, ensuring IT technical requirements are delivered effectively
Maintain end-to-end accountability for ongoing quality control, development, and delivery of IT products and services for assigned state
Partner with strategy advancement to drive initiatives such as vendor RFPs, innovation pilots, and test/learn efforts
Develop, share, and leverage best practices across IT
Influence key stakeholders, team members, and peers outside of direct control to deliver optimal solutions aligned with business partner expectations
Conduct executive-level briefings and present solution recommendations in support of state-level initiatives
Support Medicaid IT leadership in preparing readiness review materials
Act as a point of delivery escalation for respective workgroup
Ensure state leads remain organized and aligned with delivery goals
Guide Medicaid Technology Solutions teams in developing technical process documentation
Produce weekly, monthly, and quarterly Kanban updates for state-level initiatives
Partner with business teams to ensure implementation go-live activities are transitioned smoothly to markets
Work with Test Lead to develop plans of action for testing new technology products, including identifying areas to be tested and designing targeted test strategies
Work closely with implementation teams to promote responsible, high-quality testing practices
Guide testing team in developing test plans and strategies for implementations, setting priorities and direction for testing activities
Build strong working relationships with cross-department teams and demonstrate excellent interpersonal, written, and oral communication skills
Identify opportunities for implementation, testing, or IT process improvements that deliver measurable value
Provide direct or indirect oversight of test leads and technical solution professionals
Offer matrixed oversight of IT Program Managers to ensure new state implementations and existing market capabilities are delivered on time, within budget, and with high quality

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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