Clinical Strategy and Analytics Lead

Profile

Description

Humana's Clinical Strategy and Analytics team is seeking a Clinical Strategy and Analytics Lead (Strategy Advancement Advisor) to conceptualize, develop, and execute strategic, data-driven initiatives to improve healthcare value in partnership with clinical and operational leaders across the organization.

The Clinical Strategy and Analytics team is focused on improving the value of the care we provide by ensuring appropriate utilization of healthcare services while improving health outcomes and member experience. This position requires a broad understanding of the mechanisms available to health plans to impact value and improve health outcomes, and how organization capabilities interrelate across the functions or segments.

The Clinical Strategy and Analytics team is focused on improving the value of the care we provide by ensuring appropriate utilization of healthcare services while improving health outcomes and member experience. This position requires a broad understanding of the mechanisms available to health plans to impact value and improve health outcomes, and how organization capabilities interrelate across the functions or segments.

The Clinical Strategy and Analytics Lead provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for Humana operational teams, but also considers broader opportunities to deliver value to the company at large. Leads initiatives to analyze complex business problems and issues using both qualitative and quantitative data. Guides strategy to study and identify trend and savings opportunities, particularly related to utilization management and care management functions. Collaborates with operational owners to translate strategic recommendations to implementation-ready plans, while also working with actuaries to value the financial impact of the plans. Strong leadership through influence will be required to deeply integrate with the partner organizations and understand their business capabilities and barriers to execute on identified strategies.

Responsibilities

Location: Remote

The Clinical Strategy and Analytics Lead provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for Humana operational teams, but also considers broader opportunities to deliver value to the company at large. Leads initiatives to analyze complex business problems and issues using both qualitative and quantitative data. Guides strategy to study and identify trend and savings opportunities related to a number of functional areas which may include utilization management, pharmacy, value-based contracting, networks, etc. Collaborates with operational owners to translate strategic recommendations to implementation-ready plans, while also working with actuaries to value the financial impact of the plans. Strong leadership through influence will be required to deeply integrate with the partner organizations and understand their business capabilities and barriers to execute on identified strategies.

Responsibilities include:


Engage in an ambiguous problem solving and strategy setting
Use data, analytics, and industry subject matter expertise to identify opportunities to improve clinical outcomes, quality, cost, and experience for members/providers
Develop analytics protocols to identify actionable insights
Lead cross-functional teams to define discrete opportunities that are both impactful and achievable
Work directly with partners across the enterprise to create the roadmap to capture prioritized opportunities
Collaborate with a variety of partners to identify levers to address identified medical cost opportunities
Collaborate with clinicians and actuaries to forecast financial impact of initiatives
Produce high quality presentations and reports to be shared with senior leadership


Role Essentials


Bachelor's degree in business or quantitative field (business, business analytics, public health, epidemiology, data/healthcare consulting, actuarial science or any field may be considered)
6 or more years of payer and/or consulting experience in the healthcare industry
3 years' experience in strategic business role with a payer or consulting role or similar
3 years' of experience in guiding analytics/studies and analyzing data to generate insights
Knowledge of healthcare data
Demonstrated ability to define and lead large cross-organizational initiatives
Demonstrated ability to anticipate and be proactive around next steps within large initiatives simultaneously
Demonstrated ability to lead through ambiguity and function independently
Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
High learning acuity and ability to navigate rapidly changing situations and business priorities


Role Desirables


Advanced degree (Masters or Doctorate) in business (MBA) or quantitative field (MS, PhD)
Prior healthcare management consulting or project lead experience with large US-based consulting firm
Knowledge of utilization, care, and/or claims cost management processes (prior authorization, provider payment integrity, audit, waste and abuse, clinical interventions etc)
Experience with medical cost opportunity and gaps in care identification
Familiarity with various clinical terminologies and classifications (e.g., ICD10, CPT, HCPCS, DRG, CCSR, GPI)
Clinical expertise and/or education a plus
Basic understanding of data exploration and visualization tools like python, SAS, PowerBI etc


Additional Information

Humana is an organization with careers that change lives - including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

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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