Utilization Management Strategy Lead

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, Health InsuranceIndustries

Requirements

Candidates must possess a Bachelor's degree in a math or business-related field and have a minimum of two years of experience with a leading management consulting firm. Essential skills include a strong analytical and strategic mindset, the ability to interpret and leverage data for strategic improvements and recommendations, and experience influencing cross-functional groups of leaders and teams. Strong verbal and written communication skills, the ability to work independently to manage projects, and intermediate to advanced proficiency in Microsoft Office Suite (PowerPoint, Excel) are also required. Additionally, candidates need intermediate to advanced skills in navigating multiple systems/platforms and troubleshooting technical difficulties in a remote setting.

Responsibilities

The Utilization Management Strategy Lead will engage in ambiguous problem-solving and strategy setting, utilizing data and expert insights to identify key opportunities for improving clinical outcomes, quality, cost, and member/provider/associate experience. This role involves direct collaboration with cross-functional partners across the enterprise to create execution models and roadmaps for capturing prioritized opportunities. The lead will analyze complex problems related to member care and medical costs, solicit input from associates and executive leaders, guide data-backed problem-solving, and make recommendations to advance the clinical strategy. Ultimately, they will translate strategic recommendations into execution plans for operational owners.

Skills

Strategy Development

Analytical Acumen

Data-Driven Strategies

Problem Solving

Collaboration

Cross-functional Partnerships

Operational Execution

Business Metrics Analysis

Hypothesis Testing

Clinical Strategy

Healthcare Cost Control

Member Experience Improvement

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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