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At Humana, we are dedicated to delivering superior experiences and improving health outcomes for every member we serve. Our Medicare Risk Adjustment Prospective Programs Organization is looking for a Program Delivery Leader to guide strategy, planning, and performance management for risk adjustment programs focused on physician specialists. You will report directly to the Director of Risk Adjustment while developing and testing new programs that enhance in-office encounters for specialists, ensure accurate and complete documentation, and support improved member health outcomes. The Provider Program Delivery Lead will explore new opportunities, including hospital inpatient risk adjustment, using both internal solutions and external partnerships, according to Humana's strategic priorities.

This remote work opportunity requires travel to the Louisville, KY office up to six (6) times per year.

In this high-profile position you will collaborate across the enterprise to scale specialist engagement, optimize Medicare Risk Adjustment (MRA) program outcomes, and identify new opportunities for growth and performance improvement. The Provider Program Delivery Lead will work within the framework of Humana's strategic pillars: Network Growth & Enablement, Provider & Member Value, and Operational Excellence.

Responsibilities include the following:

• Develop, refine, and implement strategy for specialist risk adjustment programs, including launching new programs and optimizing existing ones.
• Lead operational planning and delivery for specialist in-office programs; implement solutions, including vendor partnerships and internal builds.
• Explore, plan, and potentially activate risk adjustment opportunities in hospital inpatient and other facility-based settings.
• Set and monitor performance goals; track important metrics, identify trends, and resolve issues.
• Communicate operational and strategic updates to senior leadership and team members, ensuring alignment and transparency.
• Partner with Operations, Finance, Analytics, and Clinical for goal setting, budgeting, and forecasting.
• Collaborate with external partners and vendors to assess and deploy solutions that scale in specialist and facility settings.
• Represent specialist risk adjustment programs in enterprise forums, providing recommendations in response to regulatory, market, and technology changes.
• Foster a culture of collaboration, accountability, and continuous improvement across the program team and broader organization.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree or equivalent experience in healthcare program delivery
• 8 or more years of experience in healthcare program management, product delivery, Medicare risk adjustment, or Stars/Quality.
• 2 or more years leading strategic programs or projects.
• Experience developing and delivering executive-level presentations and strategic communications
• Experience using data to summarize qualitative and quantitative insights into applicable program improvements
• Experience building partnerships across the organization and with external partners

Preferred Qualifications

• Master's degree in business administration, Public Health, Healthcare Administration, or related field

• Experience in risk adjustment program development for specialists, hospital inpatient, or facility-based settings

• CMS payment model and regulatory expertise

• Experience working directly with providers or vendor management

• Management consulting experience

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees 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 employees 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.

Additional Information

As part of our hiring process for this opportunity