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Responsibilities
Humana Healthy Horizons is seeking exceptional candidates to join our Medicaid Product Strategy Organization to advance Humana’s Medicaid products and capabilities and 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
The Capture Lead, Medicaid Market Entry Strategy will lead initiatives to develop and execute strategy to successfully position Humana to capture growth opportunities. This role will work horizontally across the organization, coordinating with Medicaid leadership and operational subject matter experts to synthesize, assess, and translate state requirements into actionable go-to-market strategy. The Lead will consult with growth partners to design and optimize operating model blueprints for viable Medicaid health plans that meet the needs of state clients and populations served in target growth markets.
Candidates will possess Medicaid managed care operations expertise and have experience in designing solutions for key Medicaid programs and subpopulations. Ideal candidates will possess a broad range of knowledge spanning across member, provider, and health plan administration portfolios, with areas of focus including Health Information Technology, Enrollment, Member Services, Claims, Encounters, Program Integrity, Delegation Oversight, Provider Services, Network Development, Advanced Delivery Models, and Value-Based Purchasing.
Key responsibilities include:
- 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, market intelligence, and industry best practices into a viable target operating model.
- Lead cross-functional teams of growth partners and health plan leaders to develop high-impact, innovative, and competitive market entry strategy for upcoming growth opportunities.
- Develop project plans and roadmaps, driving timely completion of 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’s operational strategy.
- Document and clearly communicate operating model features to relevant teams to support proposal development and transition to implementation.
Required Qualifications
- Bachelor’s Degree with a strong record of academic achievement.
- 5+ years’ experience in a Medicaid or Medicare Managed Care Organization.
- 5+ years’ experience in business development and strategy consulting.
- Experience and understanding of the Medicaid ecosystem, managed care health services operations, business development lifecycle, and strategic planning.
- Experience leading cross-functional teams to design a strategy and/or product.
- Strong problem-solving ability (i.e. adept at 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).
- Adept at quantitative and qualitative research.
- Excellent verbal and written communication and presentation skills.
Preferred Qualifications
- Master’s Degree in Public Health or Health Administration programs.
- MBA programs with a specialization in Healthcare Management.
- Project Management and Process Improvement qualifications.
Work at Home Requirements
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Additional Information
- Travel: Role will include travel (10-25% of time)
- Workstyle: Hybrid Office if you live within commuting distance of our office locations in Tampa, FL or Louisville, KY; Remote if you live outside of Tampa, FL and Louisville, KY
- Core Workdays & Hours: 8-5 pm Monday – Friday; Eastern Standard Time (EST) with flexible scheduling (i.e. occasional nights and weekends)
- 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.....
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.
Social Security Task
Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.
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Scheduled Weekly Hours
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