Remote Clinical Strategy and Practice Lead, RN, KY

R-315718

Description

Humana Healthy Horizons is seeking a Clinical Strategy and Practice Lead for our Equitable Population Health Management team who will build strategies for development, engagement, best clinical practices and processes for the clinical community as well as develop and manage our population health innovations and product portfolio. The Clinical Strategy and Practice Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Clinical Strategy and Practice Lead will develop and oversee the product and innovation portfolio for Humana Healthy Horizons clinical programs for our Medicaid markets.

• Collaborates closely with the Health Services Director(s), RVP, Business Development team and Medicaid Implementation team to fully operationalize the integrated clinical case management and utilization management (UM) programs.
• Utilizes clinical knowledge and skills to support the coordination, implementation, and support of Medicaid markets.
• Ensures the clinical health initiatives and services are compliant with Medicaid contracts and accreditation standards.
• Collaborates with Clinical Leaders to develop, implement and maintain Humana Healthy Horizons clinical model of care.
• Collaborates with business development as the clinical SME when pursuing new Medicaid business.
• Collaborates with vendor management to oversee and implement the clinical components of vendor contracts.

Required Qualifications

• Bachelor’s degree in business or health-related field or commensurate experience (5 years of experience in vendor oversight/management). Master’s degree a plus.
• Minimum three (3) years of Medicaid Managed Care operational experience.
• Minimum two (2) years of vendor oversight or implementation experience.
• Knowledge of the managed care industry with direct experiences in Medicaid.
• Experience in leading large-scale cross-functional projects.
• Must be able to travel to various states.
• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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.
  • Associates 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 associates 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.

Preferred Qualifications

• An active, unrestricted Registered Nurse (RN) licsense or Licensed Mental Health Practitioner or Licensed Behavioral Health professional.
• Project Management Certification (PMP).

Additional Information

• Workstyle: Home. Associates Home office environment is their primary work location, but they will use office space on an as needed basis for collaboration and other face-to-face needs.
• Travel: up to 25% to various states.
• Typical Work Days/Hours: must be able to work Monday – Friday, 8:30 am – 5:00 pm in either Eastern Time Zone (EST) or Central Time Zone (CST).
• Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Social Security Alert

Humana Values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.

Scheduled Weekly Hours

40