AVP, Medicaid Utilization & Care Strategy

Humana Inc; Phoenix (AZ); On-site; USD 230,000 - 320,000; Full time

Job summary

Humana Inc seeks an AVP, Utilization and Care Management Strategy to lead enterprise Medicaid utilization management, care management, clinical policy governance, affordability initiatives, and medical expense strategy. This role reports to the VP of Medicaid Clinical Strategy and affording oversight, shaping a cohesive strategy across markets.

This leader partners with Clinical Operations, Population Health, and Finance to align on performance, outcomes, and scalable execution, driving improved

Qualifications

• Experience shaping enterprise Medicaid strategy and related programs.
• Ability to align utilization, care management, and affordability initiatives with market needs.
• Proven track record partnering with clinical and operational leaders.

Responsibilities

• Lead enterprise Medicaid utilization and care management strategy, including strategy for prior authorization and clinical policy governance.
• Set governance routines, performance expectations, and enterprise-wide priorities for Medicaid programs.
• Oversee enterprise-wide care management strategy to ensure patient-centered, data-driven, scalable programs.
• Integrate utilization management with care management to identify high-risk members and opportunities for earlier intervention.
• Use data from authorization, denials, claims, care management, and quality metrics to drive program improvements.
• Collaborate with finance, analytics, and market leadership to develop scorecards and ROI frameworks.

Skills

Strategic leadership

Stakeholder collaboration

Utilization management

Care management

Clinical policy governance

Data-driven decisions

Education

MD/DO or equivalent

Job description

Humana Inc seeks an AVP, Utilization and Care Management Strategy to lead enterprise Medicaid utilization management, care management, clinical policy governance, affordability initiatives, and medical expense strategy. This role reports to the VP of Medicaid Clinical Strategy and affording oversight, shaping a cohesive strategy across markets.

This leader partners with Clinical Operations, Population Health, and Finance to align on performance, outcomes, and scalable execution, driving improved