Become a part of our caring community and help us put health first
 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 acquisitionCollaborate with internal stakeholders to implement and monitor clinical program enhancementsTrack and analyze data to identify trends, measure success and drive continuous improvementOversee the development, strategy and performance of the market Service Authorization reporting program, ensuring timely and accurate data collection and insightsLead cross functional teams to identify and address gaps and opportunities in service authorizationProvide actionable recommendations to enhance member outcomes and operational performanceWork collaboratively with clinical leaders to manage the clinical strategy and content of Joint Operating Committee’s with key provider groupsSet the agenda, prepare materials and facilitate discussions to align with market goalsTrack and report on clinical initiatives, ensuring alignment with contractual and regulatory requirementsDrive performance improvement in the Ohio Medicaid Managed Care ScorecardDeeply understand components of the score card and drive performance improvement across the market to optimize health plan ratingsPresent insights and updates to leadership and stakeholders, driving accountability and improvement.
Use your skills to make an impact
 

Required Qualifications

Bachelor's degree or higher3 - 5 years experience with Medicaid3 - 5 years managing large scale projects and cross functional teamsSuccess in developing working relationships within a highly matrixed business environmentAbility to analyze data and make informed recommendationsMust be passionate about contributing to an organization focused on continuously improving consumer experiences in Ohio Medicaid

Preferred Qualifications

Master's degreeExperience responding to state and/or federal government solicitationsExperience developing relationships with key stakeholders to understand and improve the market

Additional Information

Strong project management and organizational skillsAbility to analyze moderately complex data and translate findings into actionable insightsExcellent communication and facilitation skills, especially in cross functional and external meetingsProficiency 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.