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Program Delivery Lead

Humana
Remote, USA
Full-time
Senior · 8+ years experience
Remote
USD 115200-158400 yearly / year
Discovered 3 weeks ago

Full Job Posting

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The Innovation Portfolio Strategy Advisor is responsible for advancing Humana's behavioral health network quality and access across both Medicare Advantage (MA) and Medicaid (MCD) LOBs. This position will focus on developing and executing strategies to enhance provider performance, ensure true network access, and drive value-based initiatives that improve care quality and member outcomes.

Key Responsibilities

  • Network Access Monitoring:
  • Establish and maintain real-time insights into general behavioral health (BH) network access and BH specialty areas access—including Substance Use Disorder (SUD), Autism Spectrum Disorder (ASD), and Dementia—across both MA and MCD.
  • Provider Performance Measurement:
  • Develop, implement, and manage provider scorecards and tiering systems to assess and differentiate provider performance and quality.
  • Cross-functional Collaboration:
  • Partner with MA and MCD network teams, MA network adequacy team, and market leadership teams to use network data and provider performance metrics for continuous improvement of network quality and efficiency.
  • Value-Based Initiatives:
  • Launch and lead Pay-for-Performance (P4P) projects for MA providers. Support and expand ongoing P4P programs within MCD, driving provider engagement and improved member outcomes.
  • Provider Relationship Management:
  • Manage Joint Operating Committees (JOCs) and sustain ongoing relationships with large provider groups. You will be the contact for issue resolution, troubleshooting, and strategic partnership development.

Role Essentials

Bachelor’s Degree

8 +years’ experience in network strategy, provider relations, or behavioral health management within a managed care setting

Skilled in developing strategic partnerships and engaging with internal and external stakeholders to support behavioral health initiatives

Proven ability to work with multiple stakeholders, lead cross-functional teams and implement strategic initiatives

Strong analytical skills, with experience in provider performance measurement and network adequacy

Demonstrated ability to articulate ideas effectively in both written and oral forms

Role Desireables

Master’s Degree

Experience with value-based care and pay-for-performance models

In-depth knowledge of behavioral health provider networks for both MA and MCD populations

Ability to manage complex provider relationships and drive collaborative outcomes

Additional Information

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.

About us

​ 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.

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