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Clinical Business Lead, Humana Medicare Advantage

As Regional Clinical Business Lead, you serve as a key member of the regional clinical team responsible for supporting data-driven clinical strategy, performance monitoring, and continuous quality improvement within the Medicare Advantage program to support improving the health of members. The Clinical Business Lead requires close collaboration with regional leadership and cross-functional teams to ensure alignment with initiatives to drive improved member health outcomes.  The Clinical Business Lead plays a key role in advancing regional clinical strategy by working directly with the Regional Vice President of Health Services (RVP) and Health Services Director (HSD). This position focuses on enabling connections with physicians and providers, supporting innovation initiatives, implementing clinical programs, vetting new vendor programs, and ensuring performance management.

Primary Responsibilities:

Data Analytics to Support Clinical Strategy, Performance Reporting, and Monitoring:

• Analyze chronic condition performance so regional clinical leadership can bring insights to provider groups to drive awareness, education and action plans. 
• Evaluate the effectiveness of clinical program initiatives through analysis of the downstream impact of such initiatives on facility and provider performance in value-based programs.
• Identify opportunities for new clinical program initiatives by assessing cost and utilization drivers, inclusive of a chronic condition focus.
• Prepare data and evaluate performance to support RVP and HSD in governance and delegation oversight committee and interact with the corporate delegation compliance and auditing teams.

Project management and Activity tracking:

• Oversee the planning, execution, and closing of clinical projects to ensure objectives are met within required timelines and budget
• Develop and maintain detailed project plans and resource allocation schedules
• Monitor project progress, identify risks, and implement mitigation strategies
• Manage project documentation, reporting, and communication with stakeholders
• Evaluate project outcomes, perform data analysis, and present findings to leadership
• Collaborate with cross-functional teams to promote best practices and process improvements
• Ensure alignment with national and local clinical program requirements and standards
• Compliance and Quality Improvement: Participate in continuous quality improvement initiatives, including root cause analysis, best practices to close care gaps.

Vendor/Pilot Program Evaluation and Monitoring: 

• Assist in the evaluation of clinical program pilots and vendor supported initiatives through analysis and monitoring of key performance indicators.
• Review the delegation team audits and, if needed, supplement them with regular reviews to ensure vendor programs comply with regulatory standards and internal policies.
• Provide insights to inform program scalability and effectiveness.

Other duties as assigned

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree in a health-related field (Nursing, Public Health, Epidemiology, etc.)
• Minimum of 5 years of relevant experience.
• Minimum 3 years of experience in data analytics, quality, project management or process improvement.
• Proficient in analyzing data from various tools and creating actionable insights (Excel, Tableau, Power BI, databricks).
• Strong understanding of value-based care, population health, and clinical quality metrics.
• Excellent organizational, communication, and problem-solving skills.
• Proven ability to provide high-quality, responsive service to internal and external stakeholders.
• Demonstrated ability to lead through influence and collaborate across teams.
• Thrive in a remote work environment with independent work skills.
• Travel expected 5-15%

Preferred Qualifications

• Advanced Degree (such as MSN, MBA, MHA, MPH).
• Experience in managed care, health plan operations, or Medicare Advantage programs (including various SNP products) or Managed Medicaid. 
• Project management experience or certification (e.g., PMP, Lean Six Sigma).

Work-At-Home Requirements

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 t