Principal Consultant, Medicaid Medical Economics & Cost Mgt.

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The Medical Economics Principal analyzes healthcare cost, utilization, and outcomes data to inform strategies that improve affordability and quality of care. The Medical Economics Principal provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience.

At Humana, we are committed to making healthcare affordable, accessible, and high-quality. This role plays a dual role:

1. A critical leadership role responsible for translating medical economics insight into disciplined execution across clinical, behavioral health, and pharmacy cost initiatives; and

2. Leadership role overseeing the Medicaid Corporate Trend process from a business perspective partnering with Finance & Actuary.

Key Responsibilities

Clinical Strategy

• Initiative Tracking & Project Management: Lead and track specific clinical, BH, and Rx cost management initiatives across the Medicaid portfolio. Synthesize cost, utilization, and outcomes data to drive strategic decision-making, ensure initiative execution, and supports enterprise-wide cost management and medical economics strategies. Project manage best practices to drive execution, measure progress, and ensure timely delivery.
• Medical Cost Management Strategy: Develop, represent, and integrate a medical cost management plan into annual and multi-year business plans. Collaborate with leaders across Clinical, Pharmacy, Network, Product, and Claims teams.
• Business Partnership with Finance: Act as the primary business partner to Finance, translating clinical and operational insights into actionable financial impact. Develop and enhance models, metrics, and reports for effective monitoring and communication of cost management outcomes.
• Data-Driven Analysis: Analyze historical, predicted, and competitive market data to recommend benchmarks and KPIs. Generate insights to guide pricing, reimbursement, and value-based care initiatives.
• Continuous Improvement: Research industry standards, vendor solutions, and build requirements for internal solutions. Develop new approaches to improve utilization and health outcomes, collaborating flexibly with providers and cross-functional teams.

Medical Economics Trend Oversight

• Trend Stewardship: Lead as business accountability champion for quarterly reviews with Trend Stewardship Committee.
• Enterprise Accountability: Hold shared enterprise domain owners accountable for medical cost, utilization, and quality targets. Ensure alignment with Humana's strategic objectives through robust governance and reporting processes.
• Stakeholder Engagement: Build strong relationships with Market Presidents, Medical Directors, Clinical Strategy, Operations, Finance, and other key stakeholders. Ensure engagement and consensus for initiative execution and performance monitoring.

Reporting & Governance

• Reports to senior executive leadership.
• Supports governance forums and committees (e.g., Trend Stewardship Committee).
• Ensures all work adheres to Humana's compliance, data stewardship, and security standards.

Required Qualifications

• Bachelor's degree in Economics, Statistics, Public Health, Healthcare Administration, or related field.
• 10+ years of healthcare industry experience (payer, medical economics, analytics, cost management, or related).
• Demonstrated experience leading cross-functional teams and executing complex, large-scale transformation initiatives.
• Advanced analytic acumen; proficiency in Excel and data visualization tools.
• Strong understanding of healthcare reimbursement models, managed care, and principles of medical cost management.
• Proven organizational, planning, and prioritization skills.
• Highly collaborative mindset, with excellent stakeholder engagement and executive-level communication skills.
• Ability to synthesize data into actionable business insights and drive measurable improvements.

Preferred Qualifications

• MBA, Master's degree.
• Experience with Humana's organizational structure, key business domains, and data assets.

Additional Information

• Schedule/Time Zone: Monday--Friday, 8:30 AM--5:00 PM ET
• Work Location: United States (Nationwide)
• Work Style: Remote
• Travel Requirements: Up to 20--25%

Compensation & Benefits

• Pay Range: $142,300 - $195,700 per year (plus bonus incentive plan).
• Benefits: Humana offers competitive benefits including medical, dental, vision, 401(k), paid time off, and more.

About Humana

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company dedicated to making healthcare affordable, accessible, and high-quality for the millions of people we serve.

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.