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Lead-Medicaid Customer Success

Sé de los primeros solicitantes.
Humana Inc
Lincoln
A distancia
USD 94.000 - 131.000
Sé de los primeros solicitantes.
Hace 4 días
Descripción del empleo

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

The Lead - Medicaid Customer Success oversees strategy and operations for multiple Medicaid markets. This role is responsible to ensure compliance with client contracts, as well as to identify opportunities and implement program improvements to enhance our member and customer experience.

  • Partner with market, government affairs teams, sales teams define overall strategy for each Medicaid state

  • Work with market partners to perform cost / benefit analysis of potential projects

  • Manage client relationship

  • Monitor proposed regulatory changes to Medicaid and provide strategic recommendations to government affairs teams

  • Create strong partnerships with internal team members

  • Identify opportunities to improve member experience and / or profitability and manage the product life cycle from inception to implementation

  • Collaborate with business owners to streamline issue management and resolution

  • Monitor plan performance and proactively bring issues to the forefront for review

  • Support new business implementations with a goal of ensuring all pharmacy claims are processing appropriately

  • Drive project development and support project management for all product improvement initiatives

  • Create monthly business reviews and present to client

  • Escalate issues for immediate review and action whenever necessary

  • Request, review and approve data used for prioritization purposes

  • Analyze data related to pharmacy trends and collaborating with internal partners and the Medicaid market to manage pharmacy utilization and spend

  • Manage escalated member, client and / or pharmacy issues and resolve in the Medicaid market, follow through on issues to determine if they can be impacting all other markets

  • Review all requests from the standpoint of how can we make the experience better for our members, clients and partners, seek to understand the ideal impact, strive for continuous improvements.

Use your skills to make an impact

Required Qualifications

  • 3 - 5 years' experience with PBM operations

  • 3 - 5 years managing large scale projects and cross functional teams

  • Success in developing working relationships within a highly matrixed business environment

  • Ability to analyze data and make informed recommendations

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

  • Bachelor's degree

  • Experience responding to state and/or federal government solicitations

  • Experience developing relationships with key stakeholders to understand and improve the market

Additional Information:

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule

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.

SSN Alert:

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

$94,900 - $130,500 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 08-19-2025

About us

About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.

About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources

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* El índice de referencia salarialse calcula en base a los salarios que ofrecen los líderes de mercado en los correspondientes sectores. Su función es guiar a los miembros Prémium a la hora de evaluar las distintas ofertas disponibles y de negociar el sueldo. El índice de referencia no es el salario indicado directamente por la empresa en particular, que podría ser muy superior o inferior.

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