Humana

Medicaid State Technology Lead

San Antonio, Texas, United States

Not SpecifiedCompensation
Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, Information TechnologyIndustries

Requirements

Candidates must possess a Bachelor's degree in healthcare administration, public health, information systems, business, policy administration, or a related field, though relevant work experience may substitute. A minimum of 5 years of managed care experience and 5 years in Medicaid program implementation or healthcare operations, with proven leadership in complex, multi-disciplinary projects, is required. A solid understanding of payor and healthcare operations, including claims processing, enrollment, provider data management, and clinical operations (Medicaid preferred), is essential. Comprehensive knowledge of Medicaid Managed Care architecture, tools, utilities, and processes is also necessary.

Responsibilities

The Medicaid State Technology Lead will understand departmental and IT strategy, build partnerships between IT and state markets, and serve as the primary state IT implementation contact. Key responsibilities include accountability for delivery priorities, identifying and implementing best practices, coordinating issue resolution, and guiding state and market implementations. This role involves maintaining end-to-end accountability for IT product quality, partnering on initiatives like vendor RFPs and pilots, developing and sharing best practices, influencing stakeholders, and conducting executive-level briefings. The lead will support IT readiness reviews, act as a delivery escalation point, ensure state leads are organized, guide technology solutions teams in documentation, produce progress updates, and partner with business teams for smooth go-live transitions. They will also work with Test Leads to develop testing plans and strategies, promote high-quality testing practices, build strong cross-departmental relationships, identify process improvements, and provide oversight of test leads and IT Program Managers.

Skills

IT strategy
Stakeholder management
Project management
Vendor management
RFP process
Quality control
Delivery management
Problem-solving
Executive communication
Medicaid IT

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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