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The Ohio Clinical Market Development Advisor is a key leader responsible for driving strategy, operational excellence, and performance improvement in Ohio Medicaid. This position requires strong collaborative leadership in overseeing cross functional teams, managing clinical operations and ensuring the success of key market strategies, such as the Ohio Medicaid Quality Based Assignment program for new membership acquisition. This role is ideal for a strategic thinker able to deliver end to end operational performance with a deep understanding of Medicaid programs.
Key Responsibilities:
- Develop and oversee strategies to optimize the Quality-Based Assignment Program to optimize new member acquisition
- Collaborate with internal stakeholders to implement and monitor clinical program enhancements
- Track and analyze data to identify trends, measure success and drive continuous improvement
- Oversee the development, strategy and performance of the market Service Authorization reporting program, ensuring timely and accurate data collection and insights
- Lead cross functional teams to identify and address gaps and opportunities in service authorization
- Provide actionable recommendations to enhance member outcomes and operational performance
- Work collaboratively with clinical leaders to manage the clinical strategy and content of Joint Operating Committee’s with key provider groups
- Set the agenda, prepare materials and facilitate discussions to align with market goals
- Track and report on clinical initiatives, ensuring alignment with contractual and regulatory requirements
- Drive performance improvement in the Ohio Medicaid Managed Care Scorecard
- Deeply understand components of the score card and drive performance improvement across the market to optimize health plan ratings
- Present insights and updates to leadership and stakeholders, driving accountability and improvement.
Use your skills to make an impact
Required Qualifications
- Bachelor's degree or higher
- 3 - 5 years experience with Medicaid
- 3 - 5 years managing large scale projects and cross functional teams
- Success in developing working relationships within a highly matrixed business environment
- Ability to analyze data and make informed recommendations
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences in Ohio Medicaid
Preferred Qualifications
- Master's degree
- Experience responding to state and/or federal government solicitations
- Experience developing relationships with key stakeholders to understand and improve the market
Additional Information
- Strong project management and organizational skills
- Ability to analyze moderately complex data and translate findings into actionable insights
- Excellent communication and facilitation skills, especially in cross functional and external meetings
- Proficiency in Microsoft PowerPoint, Excel and other presentation, project management and reporting tools
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees 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.
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.
$94,900 - $130,500 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.
