VP, Medicaid Clinical Economics & Quality at Humana

Louisville, Kentucky, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, MedicaidIndustries

Requirements

Bachelor’s Degree/Master’s degree or Ph.D. preferred
5+ years leadership experience
10+ years relevant healthcare analytics or clinical operations, including Medicaid
Proven track record of integrating medical economics, quality, and clinical insights to drive measurable outcomes
Strong grasp of Medicaid policy, quality measurement, population health, and value-based care
Demonstrated ability to influence senior leaders and build alignment across diverse functions
Decisive, action-oriented leadership style — thrives in complexity and ambiguity, executes with urgency
Experience in Medicaid or government healthcare programs is essential (e.g., data scientist, financial analyst, economist, or other analytical professional)

Responsibilities

Lead medical cost analysis, premium analytics, and program effectiveness initiatives for Medicaid products
Oversee the creation and tracking of performance scorecards and financial metrics to optimize segment outcomes
Collaborate with actuarial, finance, and clinical teams to interpret data and inform executive decisions
Direct population health strategy, including analysis of Social Determinants of Health (SDOH) and behavioral health trends
Guide pharmacy and care management strategies using data-driven insights to improve member engagement and outcomes
Integrate analytical models and predictive tools to inform program design and measurement
Oversee quality management, including withhold management, HEDIS performance, Value-Based Payment (VBP) strategy, audits, and NCQA accreditation
Ensure compliance with Medicaid requirements and regulatory standards
Drive continuous improvement in clinical quality and member satisfaction through robust data analysis
Build, mentor, and lead multidisciplinary teams across analytics, economics, and quality functions
Foster partnerships with internal stakeholders, regulatory agencies, and external partners to advance clinical effectiveness initiatives
Serve as a strategic advisor to the executive team, translating complex analytics into actionable business insights
Drive execution excellence, ensuring strategies are implemented effectively and sustainably
Embed a culture of accountability, with transparent tracking of program effectiveness and outcomes
Deliver actionable insights that directly shape business and clinical operations

Skills

Medical Economics

Premium Analytics

Data Science

Population Health

SDOH

Behavioral Health

Pharmacy Strategy

Care Management

HEDIS

Value-Based Payments

NCQA

Performance Scorecards

Financial Metrics

Actuarial Analysis

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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