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 The SVP, Medicaid Operations will create and own the vision, mission, and strategic plan for Medicaid Clinical Operations, Account Installation, Provider Experience and Transformation, all of which are key strategic priorities for Humana’s Medicaid line of business. This work will directly impact the experience of more than 1.5 million members for a growing, Medicaid program.

The SVP will report directly to the Medicaid President and will serve as a key member of the executive leadership team, contributing to overall corporate strategy and decision-making. This role will provide executive leadership to a cross-functional team, fostering collaboration, innovation, and strategic thinking across the Medicaid and Medicare Segments.

We are looking for a dynamic and visionary SVP, Medicaid Operations to lead a team of executives focused on Clinical Operations, Account Installations, Provider Experience and Medicaid Transformation. This executive role includes overseeing and optimizing our service delivery model, ensuring compliance with regulatory standards, and driving process improvements to enhance efficiency as well as state partner and member satisfaction. The ideal candidate will lead these functions while driving sound approaches to healthcare delivery.

               

This role will oversee the alignment of technology, people and processes to develop and implement operational strategies aligned with the organization’s goals and regulatory requirements.  As an executive leader, they will be expected to work across matrixed, shared service partners to systematically cultivate, nurture, and maintain a long-term, broad network of collaborative relationships with key stakeholders (internal and external) to benefit the Medicaid segment and Humana at the organizational level. The successful candidate will be a key partner with State Plan CEOS and Divisional Leaders to ensure compliance with state contracts and drive the operationalization of data and data informed metrics to facilitate the successful operation of those plans.

Key Responsibilities

Sets the vision and strategic plan for Segment Operations and oversees all operations within Medicaid, including but not limited to:Centralized Clinical OperationsNew Market Stand up and OperationalizationBusiness Intelligence and reporting to state partnersCompliance for contractual obligations across all Medicaid MarketsOversight and support of all Market operational functionsPolicies, procedures, training, and education for all operations functions Ensures integration of clinical functions across centralized, market teams and internal and external partnersLeads the compliance function for operational quality assurance and provides strategic insight and oversight of key contractual obligations and guidance, partners with Corporate Affairs on proposed and final rules and legislation, support regulation impacts to existing programs and helps to ensure any new program changes are implemented with changing regulatory landscapeDevelops the vision and strategic plan for integrated clinical care for the Medicaid Segment.  Responsible for the experience of members and providers Sets the vision and strategic plan for prospective programs to drive operational excellence and repeatability across marketsDrives the development of internal capabilities, KPIs, Dashboards, etc  to manage plan performanceDevelops scalable operational programs through pilots, evaluations and measurable outcomesServes as a key leader/support for Medicaid Market Leadership, including Operations AVPs, Market CEOs, and Divisional Presidents.Leads a team of approximately 6 direct reports, including VPs, AVPs, and Directors with more than 200+ associates in the organization. Develops the talent and fosters a culture to meet and exceed results.

Medicaid Account Installation:

End to end implementation of new Medicaid programs, including accountability to deliver aligned and successful efforts for all enterprise partnersDrive Operational Quality Assurance efforts to ensure Medicaid compliance, including a Medicaid Compliance Committee, State Reporting and shared services oversight and governanceOversee Medicaid Market Model Deployment, readiness execution, training and hiring efforts for all market functions following an awardDeliver Market focused business intelligence that drives aligned market KPIs through the development and deployment of Market focused scorecards

Clinical Operations:

Manage clinical operations centralization efforts, maintaining a consistent approach to the Medicaid Clinical ModelEnsure high-quality care delivery and compliance with clinical guidelines, supporting contractual requirements and exceptional health outcomes for membersResponsible for the oversight and delivery of clinical technology across platforms for the Medicaid marketsGuide and support the Integrated Plan Operating Model through the development of Long-Term Services and Support (LTSS) Plan strategyLead and manage a high-performing operations team, fostering a culture of excellence and accountability
Use your skills to make an impact
 

Required Qualifications

Bachelor’s degree in healthcare administration, business, or a related field. 10 plus years in the healthcare industry, specifically in Medicare or Medicaid operations, Finance or other similar functions with a proven track record of driving quality, financial and operational performance.Expertise in the development and execution of strategy, along with a record of success working in a highly matrixed environment.8 plus years of people leadership with proven success in expanding and elevating the capabilities and performance of a multi-level team and large-scale organization.Understanding of how organization capabilities interrelate across segments and enterprise-wideDeep knowledge of the health insurance industry, competitive landscape, Medicaid operations end-to-end and a keen respect for compliance and legal guidelinesSolid finance acumen and understanding of the compensation arrangements between health plans and providersProven ability to manage the complexity of competing prioritiesRecord of success in leading large-scale, multi-function operations organizationsExcellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences, both internally and externallyHighly collaborative mindset and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs and win their co-ownership in the outcome, particularly in scenarios that call for “tough conversations” to be conductedLocation: Tampa, FL or Louisville, KY are highly preferred locations.

Preferred Qualifications

Master’s degreeExperience with platform migration, system operations and agile, strongly preferred

Additional Information

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

Health benefits effective day 1
Paid time off, holidays, volunteer time and jury duty pay
Recognition pay
401(k) retirement savings plan with employer match
Tuition assistance
Scholarships for eligible dependents
Parental and caregiver leave
Employee charity matching program
Network Resource Groups (NRGs)
Career development opportunities

Scheduled Weekly Hours

40
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.