AVP, Medicaid Utilization & Care Strategy

Humana Inc; Juneau (AK); On-site; USD 180,000 - 240,000; Full time

Job summary

Humana Inc. is seeking an experienced AVP to lead Medicaid utilization and care management strategy, partnering with clinical and operational leaders to shape enterprise priorities and governance across Medicaid markets.

The AVP will align utilization, care management, and affordability goals with quality, access, and regulatory requirements, guiding data-driven decision making and scalable execution for improved member outcomes.

Qualifications

• Experience in Medicaid managed care and utilization management.
• Ability to lead cross-functional strategy initiatives.
• Strong leadership in clinical strategy and governance.

Responsibilities

• Lead enterprise Medicaid utilization and care management strategy, including prior authorization strategy, Medicaid clinical policy governance, medical expense strategy, site-of-care optimization, provider practice variation, high-risk member strategy, and targeted affordability initiatives.
• Establish strategic direction, governance routines, performance expectations, and enterprise priorities for Medicaid utilization and care management, in partnership with operational leaders accountable for day-to-day execution.
• Oversee Medicaid care management strategy at the enterprise level to ensure programs are member-centered, data-driven, clinically effective, operationally scalable, and aligned with utilization, quality, access, regulatory, and affordability goals.
• Integrate utilization management and care management strategies to identify members with rising risk, complex needs, avoidable utilization, care gaps, and opportunities for earlier intervention, improved care coordination, and more appropriate site-of-care decisions.
• Use utilization, authorization, denial, appeal, claims, care management, quality, medical expense,

Skills

Strategic leadership

Cross-functional collaboration

Medicaid managed care

Utilization management

Clinical strategy

Education

MD/DO or equivalent clinical leadership

Job description

Humana Inc. is seeking an experienced AVP to lead Medicaid utilization and care management strategy, partnering with clinical and operational leaders to shape enterprise priorities and governance across Medicaid markets.

The AVP will align utilization, care management, and affordability goals with quality, access, and regulatory requirements, guiding data-driven decision making and scalable execution for improved member outcomes.