Become a part of our caring community and help us put health first
 

The Associate VP, Strategy Advancement provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Associate VP, Strategy Advancement requires a in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.

AVP of Clinical Operations, Cost of Care Strategy will play an important role within Clinical Operations at Humana to define, prioritize and execute on utilization management-focused initiatives to drive appropriate care in order to improve cost of care and clinical outcomes; identify efficiencies; and improve experiences across members, associates and providers.

Specifically, this AVP will be responsible for:

1) identifying opportunity areas where we can address our members receiving inappropriate care via requirement of prior authorization, policy optimization and/or consistent policy enforcement

2) identifying opportunities for reducing provider and member burden by removing prior authorization requirements at the provider, procedure and sub-procedure (e.g., diagnosis code, site of service, etc.) level

3) identifying opportunities across the auth to claims process (e.g., slippage)

4)  identify opportunities for integration of CM to improve member adherence to UM decisions/care pathways

5) managing vended OP UM relationships (e.g, Cohere), including identification of trend and process improvements

6) partner across enterprise to drive exploration and implementation of identified opportunities.

The AVP will lead a multidisciplinary team that blends strategy, policy, clinical and vendor management and will report directly to Vice President, Clinical Ops Cost of Care Strategy.

Responsibilities Include:

• Partner with analytical functions to rigorously study operational analytics, trends and outcomes in order to identify opportunities in driving appropriate clinical decisions for members through utilization management/prior authorization process

• Size impact of addressing opportunity including being responsible for assumptions and inputs used by analytic partners through pressure testing and validation using clinical literature, analysis from related initiatives, industry intelligence, feedback from markets/members/providers, etc.

• Prioritize and manage portfolio of opportunities in order to achieve annual trend targets for Clinical Operations – develop strategic framework, conduct relevant quantitative analyses and feasibility assessments to prioritize highest value strategic initiatives

• Collaborate with key partners across enterprise to co-develop strategies / priorities – working hand-in-hand with Clinical Operations and Market partners, ensuring connectivity into broader enterprise strategies and with broader clinical assets (such as Care Management, Pharmacy), informing strategies with data-driven insights from Analytics, Health Care Economics

• Translate strategies into actionable solutions and plans for execution in collaboration with key partners / stakeholders (e.g., technology, operational teams, provider experience, etc.)

• Provide team of ~15 associates with day-to-day leadership to drive progress and alignment for initiatives

  • E.g., Develop & execute process to ensure appropriate stakeholders have had opportunity to inform, decide or veto key decisions

  • E.g., Outline materials used to communicate and gain feedback on opportunity and solution to key stakeholders and decisionmakers

  • E.g., Determine key metrics and progress milestones to track against

• Proactively update and solicit senior leader alignment on key decisions through executive-level presentations and discussion facilitation

Use your skills to make an impact
 

Required Qualifications

• 10+ years of strategy, consulting and/or health plan experience

• 8+ years of team management experience

Preferred Qualifications

• Master's Degree

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$181,200 - $249,300 per year

 

This job is eligible for a bonus incentive plan. This incentive oppor