Medicaid Lead, Technology Solutions

Humana; United States; Remote; USD 117,000 - 162,000; Full time

Job summary

Join a leading healthcare organization as the Lead, Technology Solutions, focusing on Ohio Medicaid product lines. You will build strategic partnerships, manage IT solutions, and ensure compliance while driving technology initiatives to enhance consumer experiences. This role requires strong leadership and a deep understanding of healthcare operations. While primarily remote, occasional travel to state offices is necessary.

Benefits

Medical Benefits

401(k) Retirement Plan

Paid Time Off

Short-term and Long-term Disability

Qualifications

• 10+ years of experience in leading continuous improvement efforts.
• Solid understanding of Medicaid Managed Care architecture.

Responsibilities

• Builds strategic partnerships and manages relationships with business groups.
• Accountable for state technology roadmap and compliance audits.

Skills

Healthcare Operations

Continuous Improvement

Relationship Management

Education

Master's Degree

Job description

Become a part of our caring community and help us put health first
The Lead, Technology Solutions devises an effective strategy for executing and delivering on IT business initiatives. The Lead, Technology Solutions works on problems of diverse scope and complexity ranging from moderate to substantial.

Role Description

The Medicaid Lead, Technology Solutions builds strategic partnerships and manages relationships between IT and the aligned business group(s). The Lead facilitates guidance to business partners on information technology (IT) solutions, stays current on and leverages industry trends, and challenges business and IT to drive for best outcomes by leveraging the best technology solutions. This is achieved by having a clear understanding of business, its strategic direction, and targeted outcomes along with technology trends both internal and external to the organization. The role serves as the Single Point of Contact representing assigned business area(s) to the IT organization and representing Humana IT with internal business partners along with State and Federal regulators. The Lead contributes to RFP responses to ensure they are accurate and reflect the true and competitive capabilities Humana brings to the table, ensures internal SLAs are in place to support contracts and technology is configured to operate within contractual obligations. The Lead drives solutions at an organizational level to provide maximum value and align to the overarching IT strategy.

Responsibilities

• This State Technology Lead role will exclusively cover the Ohio Medicaid product lines.
• This State Technology Lead must reside full-time within the state of Ohio
• Builds and maintains relationships with regulators and business leaders to understand the business strategy and needs and to advocate technology solutions to deliver results.
• Participated in state Readiness Reviews, including arranging with other IT experts to present, as needed, for topics where additional expertise may be needed
• Stays current on relevant technologies leading efforts to match business needs with best technology solutions
• Organize and run any one-time or recurring technology-related meetings with state personnel, and/or with the state’s technology partner
• Provide thought leadership for state regulators, Humana market leaders, and occasionally other MCOs when multi-MCO implementations are involved
• Collaborate with Market Operations/leadership in problem solving and help with workarounds as required to meet state deadlines that are in significant conflict with Humana IT’s development timelines
• Serves as the “Senior Business Architect” for Medicaid, with a strong understanding of how the industry’s standard processes are executed in Humana’s environment, from end to end
• Help develop and maintain all state-level Humana IT P&Ps, working with Humana IT compliance, the Privacy Office, and other internal areas as needed
• Be on point for the technology portion of all state Medicaid compliance audits. These will often tie back to P&Ps
• Participate in Command Centers or other operationally focused meetings as determined by each market
• Participate in Market President’s senior leadership meetings, as appropriate
• Ensure documentation is gathered and distributed to the appropriate market and IT peers for any state led meetings
• Accountable for partnering with IT Operations in monitoring contractual SLA performance for State contracts to successfully deliver and avoid potential millions in liquidated damages and maximize revenue
• Responsible for state technology roadmap including delivery of strategic imperatives to position to win and re-win contracts at renewal
• Accountable for collaborating with business and IT peers to collect, maintain and store specifications, documentation, design documents, process flows, etc. relating to the state implementation.
• Work with teams to gathers business requirements and clarify scope during initial discovery by conducting meetings/interviews, and facilitating large group/cross-functional sessions with partners
• Effectively influences key stakeholders, team members, and peers outside of direct control of this role, to deliver optimal solutions in line with the best interests and expectations of the business partner.
• Conducts executive level briefings presentations and solution recommendations

Use your skills to make an impact

Required Qualifications

• Solid understanding of operations, technology, communications, and processes
• Solid understanding of healthcare operations, particularly around claims processing, enrollment, provider data management and clinical operations; Medicaid preferred
• Comprehensive understanding of a Medicaid Managed Care architecture, tools, utilities and processes utilized to deliver on core competences
• Possess 10+ years of progressive experience leading continuous improvement efforts, evaluating existing systems and implementing process improvements.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

***While this is a remote opportunity, it will require the willingness to travel to the market office and state office as needed***

Preferred Qualifications

• Master's degree

Additional Information

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

• Satellite and Wireless Internet service is NOT allowed for this role.

• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

#LI-Remote

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.$117,600 - $161,700 per yearThis 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.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.