Capture Lead, Medicaid Clinical & Population Health Strategy

About the position Become a part of our caring community and help us put health first. Humana Healthy Horizons is seeking a Capture Lead, Clinical & Population Health Strategy, to lead initiatives developing and executing strategy to successfully position Humana for capture growth opportunities. This role will work horizontally across the organization, coordinating with Medicaid and Medicare leadership and clinical subject matter experts to synthesize, assess, and translate state requirements into actionable go-to-market clinical strategy. The Lead will consult with growth partners to design and optimize clinical operating model blueprints for viable Medicaid health plans that meet the needs of state clients and populations served in target growth markets. The Lead, Medicaid Clinical & Population Health Strategy, will advance Humana's Medicaid products and capabilities to support the strategic direction and growth of the Medicaid and Duals lines of business. This is a unique opportunity for a motivated individual to influence the mission of a leading healthcare company committed to improving the health of the communities it serves. The Medicaid Capture Management team's purpose is to successfully position Humana to enter new markets enabling the future of the business. As a centrally positioned strategic function, this team coordinates with growth partners across the enterprise and industry to accelerate product strategy and define the operating model for new markets. We deliver value through detailed research, data-driven insights, strategic planning, structured problem solving, and project management rigor. We are a diverse set of highly skilled people with deep Medicaid subject matter expertise who work in an agile, collaborative environment. To achieve our goals, we empower associates to pioneer simplicity, rethink routine and seek talent with the following attributes: Creative - Adept at research to determine the opportunity and a structured yet flexible approach to problem solving. Adaptive - Rapidly learn new knowledge, skills, and behaviors in response to changing circumstances. Self-sufficient - Ability to navigate complex situations and independently produce high quality deliverables. Consultative - Build/sustain relationships and inform the work of others through actionable, objective insights. Strategic - Forward thinking capable of providing frameworks to maximize ability of limited resources to achieve growth. Candidates will possess Medicaid managed care operations expertise and have experience in designing solutions for key Medicaid programs and subpopulations. Areas of focus include Care Management, Quality Improvement, Utilization Management, Population Health, Social Determinants of Health, Pharmacy, Behavioral Health, Institutional Long-Term Services and Supports (LTSS), Home and Community Based Services, Medicaid and Medicare integration, D-SNPs, and Self-Directed Services. Responsibilities • Research and assess prospective new markets. Gather key information on market and regulatory landscape and translate state policy to discern impacts to Humana's operating model. , • Coordinate operational teams to translate contract requirements, CMS regulations, market intelligence, and industry best practices into a viable target operating model. , • Lead cross-functional teams of growth partners and health plan leaders to design high-impact, innovative, and competitive clinical programs, models, partnerships, and initiatives for upcoming growth opportunities. , • Develop project plans and roadmaps, driving timely completion of clinical deliverables by cross-functional project team. , • Track project status and report on progress to leadership. , • Participate in the proposal development process. Provide content and recommendations to help shape responses to state procurements and clearly articulate Humana clinical product strategy. , • Document and clearly communicate clinical operating model features to relevant teams to support proposal development and transition to implementation. Requirements • Must work hours within the Eastern Standard Time Zone. , • Bachelor's degree with a strong record of academic achievement. , • 5+ years of experience in a Medicaid Managed Care Organization (MCO) focusing on Medicaid clinical strategy and population health management strategy. Alternatively, 5+ years of experience in strategy consulting supporting Medicaid managed care clinical strategy and population health management strategy. , • 5+ years of experience leading cross-functional teams to design and implement Medicaid clinical or population health management strategies or products. , • 5+ years of experience supporting Medicaid managed care health services operations and the Medicaid managed care business development lifecycle. , • Strong problem-solving ability (i.e. adept at quantitative and qualitative research and generating creative solutions). , • Ability to operate in a fast-paced environment under tight deadlines and in ambiguous situations. , • Highly organized and analytical with a strong attention to detail. , • Advanced Proficiency in Microsoft Office Products (i.e. Word, Excel, PowerPoint, Visio). , • Excellent verbal and written communication and presentation skills. Nice-to-haves • Master's degree in public health or health administration programs. , • MBA programs with a specialization in Healthcare Management. , • Project Management and Process Improvement qualifications. , • Experience and understanding of the delivery system for dual eligibles, including D-SNPs. Benefits • Benefits are effective on day 1. , • Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more. Apply Job!