Clinical Strategy Lead

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.

The Clinical Strategy Team is a multi-disciplinary team focused on using data analysis and clinical acumen to build strategies that improve experiences for our members and providers, drive positive health outcomes, and reduce total cost of care. We are seeking a Clinical Strategy Lead to build-out our strategy and approach to ensure our members get the highest quality care, which may include supporting our members going to the highest quality providers, while also understanding root causes of high and low quality care and building strategies to improve quality of care offered. This will involve close partnership with analytical and clinical SMEs to identify opportunity areas, and operational business partners to bring strategies to life. Purpose is to help our members achieve optimal health outcomes and cost-effective care. Location: remote The Clinical Strategy Lead will lead high-value, strategic initiatives that directly impact health outcomes and total cost of care of Humana’s 5M+ membership. The Clinical Strategy Lead will partner with analytics and clinical SMEs to improve our understanding of provider quality and performance, and then figure out how we support our members getting the highest quality care. This may include identifying new approaches to influence members going to the highest quality providers, as well as understanding root causes of high and low quality care and building strategies to improve quality of care offered. In this Lead role, you’ll have the opportunity to analyze complex business and clinical issues leveraging healthcare and operational data, while working collaboratively with clinicians, data scientists, actuaries, subject matter experts, and business owners across Humana to drive solutions forward. In this role you will lead quantitative and qualitative analysis to identify actionable insights and bring the insights to action through cross-organizational collaboration.

Identify ways to use Humana capabilities to improve members getting best quality care, which may include ways to influence members choosing or getting referred to the highest quality providers, as well as ways to influence providers to improve quality of care offered. Develop a strategy and recommendations based on opportunity areas identified in partnership with analytics, clinical SMEs and operational partners, get buy-in from leadership and business partners, and help guide implementation. Partner closely with data scientists, actuaries, and clinical associates to frame-up an analytics question, guide analysis, and draw actionable insights to inform strategy. Synthesize evidence from clinical literature and guidelines, as well as conduct more broad external research (e.g. competitive intelligence), to come up with ideas on approach. Develop a learning agenda and test plans to ensure we get the learnings from new initiatives to understand their impact and inform future direction. Utilize strong interpersonal skills, presentation skills, and storytelling skills to get alignment on initiatives among senior leaders, business partners and other stakeholders. Produce high quality presentations and reports, to be shared with senior leaders, business partners, and other stakeholders. Work cross-functionally with key partners to drive results. Identify important clinical and experience problems and build the business case to solve them through application of clinical, analytical, and business expertise.