AVP, Clinical Operations Cost of Care Strategy - Humana
Pierre, SD
About the Job
Become a part of our caring community and help us put health first
The Associate VP, Strategy Advancement provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Associate VP, Strategy Advancement requires a in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.
AVP of Clinical Operations, Cost of Care Strategy will play an important role within Clinical Operations at Humana to define, prioritize and execute on utilization management-focused initiatives to drive appropriate care in order to improve cost of care and clinical outcomes; identify efficiencies; and improve experiences across members, associates and providers.
Specifically, this AVP will be responsible for:
1) identifying opportunity areas where we can address our members receiving inappropriate care via requirement of prior authorization, policy optimization and/or consistent policy enforcement
2) identifying opportunities for reducing provider and member burden by removing prior authorization requirements at the provider, procedure and sub-procedure (e.g., diagnosis code, site of service, etc.) level
3) identifying opportunities across the auth to claims process (e.g., slippage)
4) identify opportunities for integration of CM to improve member adherence to UM decisions/care pathways
5) managing vended OP UM relationships (e.g, Cohere), including identification of trend and process improvements
6) partner across enterprise to drive exploration and implementation of identified opportunities.
The AVP will lead a multidisciplinary team that blends strategy, policy, clinical and vendor management and will report directly to Vice President, Clinical Ops Cost of Care Strategy.
Responsibilities Include:
+ Partner with analytical functions to rigorously study operational analytics, trends and outcomes in order to identify opportunities in driving appropriate clinical decisions for members through utilization management/prior authorization process
+ Size impact of addressing opportunity including being responsible for assumptions and inputs used by analytic partners through pressure testing and validation using clinical literature, analysis from related initiatives, industry intelligence, feedback from markets/members/providers, etc.
+ Prioritize and manage portfolio of opportunities in order to achieve annual trend targets for Clinical Operations – develop strategic framework, conduct relevant quantitative analyses and feasibility assessments to prioritize highest value strategic initiatives
+ Collaborate with key partners across enterprise to co-develop strategies / priorities – working hand-in-hand with Clinical Operations and Market partners, ensuring connectivity into broader enterprise strategies and with broader clinical assets (such as Care Management, Pharmacy), informing strategies with data-driven insights from Analytics, Health Care Economics
+ Translate strategies into actionable solutions and plans for execution in collaboration with key partners / stakeholders (e.g., technology, operational teams, provider experience, etc.)
+ Provide team of ~15 associates with day-to-day leadership to drive progress and alignment for initiatives
+ E.g., Develop & execute process to ensure appropriate stakeholders have had opportunity to inform, decide or veto key decisions
+ E.g., Outline materials used to communicate and gain feedback on opportunity and solution to key stakeholders and decisionmakers
+ E.g., Determine key metrics and progress milestones to track against
+ Proactively update and solicit senior leader alignment on key decisions through executive-level presentations and discussion facilitation
Use your skills to make an impact
Required Qualifications
+ 10+ years of strategy, consulting and/or health plan experience
+ 8+ years of team management experience
Preferred Qualifications
+ Master's Degree
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$181,200 - $249,300 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
The Associate VP, Strategy Advancement provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Associate VP, Strategy Advancement requires a in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.
AVP of Clinical Operations, Cost of Care Strategy will play an important role within Clinical Operations at Humana to define, prioritize and execute on utilization management-focused initiatives to drive appropriate care in order to improve cost of care and clinical outcomes; identify efficiencies; and improve experiences across members, associates and providers.
Specifically, this AVP will be responsible for:
1) identifying opportunity areas where we can address our members receiving inappropriate care via requirement of prior authorization, policy optimization and/or consistent policy enforcement
2) identifying opportunities for reducing provider and member burden by removing prior authorization requirements at the provider, procedure and sub-procedure (e.g., diagnosis code, site of service, etc.) level
3) identifying opportunities across the auth to claims process (e.g., slippage)
4) identify opportunities for integration of CM to improve member adherence to UM decisions/care pathways
5) managing vended OP UM relationships (e.g, Cohere), including identification of trend and process improvements
6) partner across enterprise to drive exploration and implementation of identified opportunities.
The AVP will lead a multidisciplinary team that blends strategy, policy, clinical and vendor management and will report directly to Vice President, Clinical Ops Cost of Care Strategy.
Responsibilities Include:
+ Partner with analytical functions to rigorously study operational analytics, trends and outcomes in order to identify opportunities in driving appropriate clinical decisions for members through utilization management/prior authorization process
+ Size impact of addressing opportunity including being responsible for assumptions and inputs used by analytic partners through pressure testing and validation using clinical literature, analysis from related initiatives, industry intelligence, feedback from markets/members/providers, etc.
+ Prioritize and manage portfolio of opportunities in order to achieve annual trend targets for Clinical Operations – develop strategic framework, conduct relevant quantitative analyses and feasibility assessments to prioritize highest value strategic initiatives
+ Collaborate with key partners across enterprise to co-develop strategies / priorities – working hand-in-hand with Clinical Operations and Market partners, ensuring connectivity into broader enterprise strategies and with broader clinical assets (such as Care Management, Pharmacy), informing strategies with data-driven insights from Analytics, Health Care Economics
+ Translate strategies into actionable solutions and plans for execution in collaboration with key partners / stakeholders (e.g., technology, operational teams, provider experience, etc.)
+ Provide team of ~15 associates with day-to-day leadership to drive progress and alignment for initiatives
+ E.g., Develop & execute process to ensure appropriate stakeholders have had opportunity to inform, decide or veto key decisions
+ E.g., Outline materials used to communicate and gain feedback on opportunity and solution to key stakeholders and decisionmakers
+ E.g., Determine key metrics and progress milestones to track against
+ Proactively update and solicit senior leader alignment on key decisions through executive-level presentations and discussion facilitation
Use your skills to make an impact
Required Qualifications
+ 10+ years of strategy, consulting and/or health plan experience
+ 8+ years of team management experience
Preferred Qualifications
+ Master's Degree
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$181,200 - $249,300 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana
