Senior Strategy Advancement Professional, Medicaid Capture Management

San Antonio, Texas, United States

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Not SpecifiedCompensation

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

Full TimeJob Type

UnknownVisa

Healthcare, Insurance, Government ProgramsIndustries

Requirements

Candidates must possess Medicaid managed care operations expertise and experience in designing solutions for key Medicaid programs and subpopulations, including areas like Care Management, Quality Improvement, Utilization Management, Population Health, Social Determinants of Health, Pharmacy, Behavioral Health, Long-Term Services and Supports, Health Information Technology, Enrollment, Member Services, Grievance and Appeals, Claims, Encounters, Program Integrity, and Subcontractor Management. The role requires creative, adaptive, self-sufficient, consultative, and strategic attributes, with the ability to research, problem-solve, learn quickly, navigate complex situations independently, build relationships, and provide actionable insights.

Responsibilities

The Senior Strategy Advancement Professional will support initiatives to develop and execute strategy for capturing growth opportunities within Humana's Medicaid business. This involves horizontally coordinating with Medicaid leadership and subject matter experts to translate state requirements into go-to-market strategy, and consulting with growth partners to design and optimize operating model blueprints for viable Medicaid health plans. Key responsibilities include researching and assessing prospective new markets, translating state policy to discern impacts on Humana's operating model, coordinating operational teams to create target operating models, designing innovative programs and partnerships for growth opportunities, developing project plans and roadmaps, tracking project status, reporting progress to leadership, and participating in proposal development by providing content and recommendations for state procurements.

Skills

Medicaid

Strategy

Capture Management

Go-to-market strategy

Operating model design

Research

Data analysis

Strategic planning

Problem-solving

Project management

Agile methodology

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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