Clinical Strategy and Practice Lead Medicaid Implementation - UM/Population Health

Profile

Description

Humana Healthy Horizons is seeking a Clinical Strategy and Practice Lead to support the clinical design and implementation for new state contracts. The Clinical Strategy and Practice Lead will develop processes and manage the implementation for end to end clinical operations of new markets. The Clinical Strategy and Practice Lead requires a solid understanding of health plan operations and how organization capabilities interrelate across departments.

Responsibilities


Provides oversight of clinical implementation processes, managing company adherence to standard implementation processes for both Business and IT.
Leads large scale clinical cross functional projects and initiatives across the entire enterprise to deliver new market implementation.
Develops and supports clinical processes, policies and procedures with working knowledge of clinical compliance requirements.
Manages business and program implementations to meet budget, timeline, and contractual requirements.
Provides input on development of operating models, including standard foundational integrated clinical model, system models, performance metrics, expected outcomes and plan impacts.
Coordinates enterprise wide cross-functional tasks between various internal and external areas to ensure successful project and implementation outcomes.
Communicates project/implementation status to all internal and external stakeholders.
Collaborates with implementation team members and stakeholders using appropriate tools and techniques to increase and maintain commitment to objectives.
Identifies and reduce redundancies among implementations when necessary.
Identifies and develop contingency plans to mitigate and address risks.
Supports Market leadership in delivering the contractual obligations required under the State Medicaid Contract.


Required Qualifications


Bachelor's Degree or equivalent experiences in Clinical Healthcare Operations
Two (2) or more years of leadership experience.
Possess a solid understanding of healthcare operations, technology, communications, and processes.
Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of a management team.
Demonstrated skills in executing on strategic playbooks or roadmaps in alignment with organizational goals.
Ability to identify, structure and recommend solutions/options to meet business stakeholder contractual compliance for implementation.
Experience operating in matrixed and agile environment.
Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.


Preferred Qualifications


Two (2) or more years of technical and/or business project management experience.
Experience in Utilization Management with UM clinical reviews, ASAM, MCG, UM training and UM process development and/or Policies.
Experience in Population Health or community public health and knowledge of strategic design, operational implementation plan, and ongoing evaluation of population health initiatives such as health needs of the underserved to influence department's strategy.
Knowledge of Systems Development Life Cycle, Waterfall, and Agile Development Methodologies.
Proficiency in Microsoft Office programs.
Experience working in Medicaid and/or Medicare.
Six Sigma and / or Project Management Institute certification.


Additional Information


Work Days & Hours: Monday - Friday; Eastern Standard Time (EST)
Travel : Up to 10%-Possibly outside of your state of residence.


Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

Company info

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