DSNP Strategy Advancement Advisor

Become a part of our caring community and help us put health first
 

The DSNP Strategy Advancement Advisor 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 Strategy Advancement Advisor works on problems of diverse scope and complexity ranging from moderate to substantial.

The DSNP Strategy Advancement Advisor leads initiatives to analyze complex business problems and issues using data from internal and external sources. Brings expertise or identifies subject matter experts in support of multi-functional efforts to identify, interpret, and produce recommendations and plans based on company and external data analysis. Ensures that policies and procedures align with corporate vision. Selects, develops, and evaluates personnel ensuring efficient operation of the function. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Key Functions:

• Serves as a liaison between Humana utilization management (UM) operations, Humana’s Risk and Compliance lines of defense, and the State of Michigan regarding prior authorization reviews, prepayment retrospective reviews, and any additional utilization management functions.

• Develop and implement utilization management strategies that align with organizational goals.

• Ensure the efficient use of healthcare resources while maintaining high-quality patient care.

• Serves as the primary liaison between Medicare and Medicaid teams for all DSNP activities.

• Understands and clearly articulates differences and intersections between Medicare and Medicaid Utilization Management processes.

• Coordinates and facilitates cross-functional meetings focused on DSNP planning, UM alignment, and process resolution.

• Identifies and addresses any concerns related to UM workflows, ensuring clarity and consistency across both lines of business.

• Supports state reporting efforts by understanding requirements and ensuring there is clear ownership and accountability.

• Participates in DSNP implementation planning, including reviewing project plans and providing input on staffing needs.

• Engages regularly with Medicaid market leaders to provide updates, gather feedback, and ensure there are no gaps or misalignments.

• Provides guidance on potential impacts across people, process, and technology related to DSNP implementation.

• Leads or supports cross-functional workgroups to address DSNP-specific operational needs.

• Assists with governance and quality-related items such as QIE/QIC reporting and issue resolution.

• Liaison for the DSNP PAL.

• Acts as a strategic partner ensuring operational readiness and alignment for a successful DSNP launch and sustainability.

Use your skills to make an impact
 

REQUIRED QUALIFICATIONS:

• Bachelor's degree or equivalent experience

• 5+ years of previous clinical experience in utilization management

• 2+ years of indirect or direct leadership experience

• Comprehensive knowledge of Microsoft Office applications including PowerPoint, Word, Excel, and Outlook

• Knowledge of regulatory requirements and National Committee for Quality Assurance (NCQA) standards

PREFERRED QUALIFICATIONS:

• Registered nurse (RN) with unrestricted licensed OR independent licensed clinical social worker (LCSW)

• Master’s degree

• Knowledge of Medicaid regulatory requirements

• Experience with contracting, audit, risk management, or compliance

Additional Information

This position is open to work remote

Work at Home Criteria  

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 recommended; 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.  

 

 Interview Format  

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. Modern Hire 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.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

 

$115,200 - $158,400 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.

Application Deadline: 06-26-2025

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.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.