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Humana Director, HQRI Strategy in Springfield, Missouri

Description

Humana is a Fortune 60 market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.

Against that backdrop, we are seeking an experienced healthcare leader to join our team as Director of Strategy for our Healthcare Quality Reporting and Improvement (HQRI) organization. HQRI is an organization that is responsible for improving health outcomes and advancing the care experience of our members and provider partners. It is comprised of two main teams: Risk Adjustment and Health Quality & Stars. The Risk Adjustment team collects and submits members' health information to CMS for the purpose of generating accurate reimbursement for coverage, as well as inclusion in the appropriate clinical programs. The Health Quality and Stars team centralizes quality improvement and governance processes targeting Humana's Medicare Advantage members, and also manages compliant data submissions to CMS in adherence with the Stars Rating Program.

The Director will play a key leadership role on the HQRI team, partnering directly with the HQRI leadership team, leaders across the enterprise, including Market leadership, and external companies to create Medicare Risk Adjustment strategies to support Humana's industry leading position. This person will also establish relationships with external vendors whose products may be valuable resources for supporting our business goals, or viable solutions to business challenges that have been identified. In addition, the Director will serve as a central point of contact for the lines of business as relates to key Stars and Risk Adjustment initiatives.

In this newly-defined role, the Director will build from scratch a small team that will provide product management and strategy support at a more operational level. This position will report directly to the Senior Vice President of HQRI and can be based anywhere within the lower 48 states.

Responsibilities

Key Responsibilities

  • Deliver on a wide range of strategy and development activities, including business unit level strategy and enterprise level partnerships

  • Convert strategy/development priorities into business cases and projects while prioritizing timelines and ensuring consensus and execution

  • Refine strategy for Risk Adjustment and Stars/Quality with respect to new clinical programs, connecting to both existing work within the enterprise and new opportunities

  • Leverage external industry experience to identify new opportunities to maintain competitive advantage in the market with respect to Risk Adjustment and Stars/Quality

  • Collaborate with Retail leaders to develop and deliver executive and market level reporting for Stars/Quality and Risk Adjustment.

  • Conceptualize, develop, and execute new opportunities in conjunction with corporate and market partners.

  • Develop and manage annual Operational and Key Results for HQRI that are tracked at the enterprise level.

  • Support Enterprise Merger and Acquisition partners to evaluate potential procurement opportunities focuses on risk adjustment capabilities.

  • Identify opportunities and impacts as a results of Centers for Medicare and Medicaid Innovation enhancements and offerings.

  • Partner with Government Affairs to ensure focus on new and future regulations and policy.

  • Compose responses to industry based inquiries in partnership with Corporate Communications.

  • Represent SVP, HQRI in enterprise level to ensure all Risk Adjustment and Stars/Quality impacts and opportunities are considered

  • Keep a close connection to market trends and external opportunities, including developing and growing professional network in key strategic areas

Key Candidate Qualifications

The ideal candidate will have current or recent industry experience on the payer side (typically at least two years) specific to risk adjustment and quality. That experience should also include creation and ownership of strategies for a large business unit. This person will also have a proven record of success in orchestrating the efforts of cross-functional colleagues in large-scale projects. Bachelor's degree in a relevant field is required.

In addition to the above, the following technical qualifications and personal attributes are also sought:

  • Strong business acumen and analytical skills

  • Ability to identify, structure and solve ambiguous business problems

  • The ability to 'connect the dots' and understand how to optimize system-level processes and resources

  • A record of success in attracting, developing, and motivating top talent from inside and outside of the organization, and preparing direct reports for expanded responsibilities

  • Experience in managing change by leading and energizing others, modeling adaptability, and inspiring strong organizational performance through periods of transformation, ambiguity, and complexity.

  • Excellent relationship-building skills and proven ability to work collaboratively through various departments and functional areas, promoting a culture of proactive teamwork.

  • Current or recent experience in a large, highly matrixed company, with proven ability to influence leaders and key stakeholders in such an environment

  • Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences

  • Vendor management experience

  • MBA preferred

Scheduled Weekly Hours

40

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