Strategy Advancement Advisor

Employment Type: Full-time

Position Overview

Become a part of our caring community and help us put health first. The Strategy Advancement Advisor provides data-based strategic direction to identify and address business issues and opportunities. This role provides business intelligence and strategic planning support for business segments or the company at large. The Strategy Advancement Advisor works on problems of diverse scope and complexity ranging from moderate to substantial.

The Strategy Advancement Advisor leads initiatives to analyze complex business problems and issues using data from internal and external sources. This role brings expertise or identifies subject matter experts in support of multi-functional efforts to identify, interpret, and produce recommendations and plans based on company and external data analysis. Ensures that policies and procedures align with corporate vision. Selects, develops, and evaluates personnel ensuring efficient operation of the function. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Key Functions

Strategic Planning and Implementation

• Develop and implement utilization management strategies that align with organizational goals.
• Ensure the efficient use of healthcare resources while maintaining high-quality patient care.

Cost Containment

• Identify opportunities for cost savings through effective utilization management practices.
• Monitor and analyze utilization data to detect trends and areas for improvement.
• Implement cost-effective measures without compromising patient outcomes.

Centralized Governance

• Establish standardized protocols and workflows across the enterprise.
• Lead activities regarding UM annual evaluation.
• Lead activities related to UM Program Description.

Data Analysis and Reporting

• Utilize data analytics to track performance metrics and identify areas for optimization.
• Provide detailed reports to stakeholders on utilization trends and cost containment efforts.

Stakeholder Collaboration

• Work closely with clinical teams, finance departments, and other stakeholders to ensure cohesive utilization management practices.
• Facilitate communication and coordination between different departments.
• Serve as a point of contact to strategize and coordinate with DSNP programs.

Use your skills to make an impact!

Requirements

Required Qualifications

• Registered nurse (RN) with unrestricted licensed OR independent licensed clinical social worker.
• 5+ years of previous clinical experience in utilization management.
• 2+ years of indirect or direct leadership experience.
• Comprehensive knowledge of Microsoft Office applications including PowerPoint, Word, Excel, and Outlook.
• Knowledge of regulatory requirements and National Committee for Quality Assurance (NCQA) standards.

Preferred Qualifications

• Master’s degree.
• Knowledge of Medicaid regulatory requirements.
• Experience with contracting, audit, risk management, or compliance.

Additional Information

This position is open to work remote.

Work at Home Criteria

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space.