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This enterprise executive role is responsible for leading Medicaid clinical operations, including utilization management, care management, and clinical program delivery. You will translate strategy, market requirements, and regulatory expectations into standardized operating models and scalable workflows to ensure operational excellence.
This position is remote, with a strong preference for candidates residing in Tampa, FL, or Louisville, KY.
Key Responsibilities
Clinical Operations Leadership
- Lead clinical and nonclinical teams supporting utilization management, care management, and program operations.
- Establish operating rhythms, accountability structures, and performance management processes.
- Foster a high-performing culture focused on associate development, retention, and operational discipline.
Healthcare Transformation and Strategy
- Develop and execute clinical operations strategies to support growth, market expansion, and state contract requirements.
- Lead operational readiness for new markets and enterprise transformation initiatives.
- Drive standardization and workflow optimization to improve scalability and performance.
Utilization Management, Care Management, and Integrated Care Delivery
- Oversee utilization and care management functions, ensuring regulatory compliance and timely decision-making.
- Advance integrated care models addressing physical health, behavioral health, LTSS, and social needs.
- Strengthen care navigation and interventions to improve health outcomes and reduce avoidable utilization.
Performance, Financial, Risk Management and Technology Partnership
- Partner with Product, Technology, and Data teams to translate operational needs into business requirements and technology solutions.
- Manage budgets, staffing models, and labor efficiency in partnership with Finance.
- Identify performance gaps and implement mitigation plans to manage clinical and operational risk.
Cross-Functional and Matrixed Partnerships
- Collaborate with Medicaid markets, Medicare, Quality, Compliance, and Legal teams to deliver integrated outcomes.
- Serve as a key liaison for DSNP alignment and cross-functional stakeholder engagement.
- Represent clinical operations in executive forums and transformation governance.
Qualifications
- Bachelor's degree required; advanced degree in a related field preferred.
- Clinical license, nursing degree, or other healthcare credential strongly preferred.
- 10+ years of progressive experience in Medicaid, managed care, or healthcare transformation.
- 5+ years leading large, distributed clinical or operational teams.
- Deep understanding of Medicaid programs, state contracts, and integrated care models.
- Strong financial acumen and experience managing budgets and performance metrics.
- Proven ability to lead through ambiguity and influence cross-functionally.
Work at Home Requirements
- Minimum internet speed: 25 Mbps download / 10 Mbps upload.
- Dedicated workspace free from interruptions to protect PHI/HIPAA information.
- Occasional travel to offices for training or meetings may be required.
About Humana
Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company dedicated to helping people achieve their best health. We serve millions of members across Medicare, Medicaid, and other programs.
Equal Opportunity Employer
Humana is an equal opportunity employer and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or protected veteran status.