Utilization Management Evolution Strategy Advancement Advisor

Profile

Description

Utilization Management Evolution Strategy Advancement Advisor provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Utilization Management Evolution Strategy Advancement Advisor works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

Location: remote

The Utilization Management Evolution Strategy Advancement Advisor for Utilization Management (UM) role focuses on expanding our relationship with UM partners to improve the provider experience through the outpatient authorization process while leading to improvements in clinical quality and reducing trend and administrative expenses. Provides business intelligence and strategic planning to develop differentiated capabilities to align authorization along member care pathways and leverage advanced analytics both to increase auto-approval rates, and to influence provider behavior.

Key Responsibilities

Accountable for the full end-to-end program, strategic planning, pricing, roadmap development and execution of an integrated clinical portfolio

Makes decisions with minimal supervision, exercise independent judgment and decision making on complex issues regarding job duties and related tasks

Investigates facts and develops solutions to problems during the design and planning phases

Defines the core metrics that will inform the success of the integrated product(s)

Provides strategic recommendations on new opportunities, assesses needs and builds ROI driven business plans

Work with key partners closely within operations, vendors, and/or enterprise teams, to drive the development and execution of a multi-year business roadmap.

Develop plans of action to prevent delays in projects.

Monitor the progression of investment delivery to ensure business needs are satisfied against expectations.

Responsible for reporting on outcomes as well as providing timely and accurate information and status updates to functional leaders

This role requires 10 - 20% travel to Louisville, Boston and other market areas

Role Essentials

Bachelor's degree

7 or more years of strategy, product management and/or program management experience

Healthcare experience

Proven record in developing clinical strategy, vision and roadmap

Ability to drive significant transformation

Solid track record of driving solutions that achieved clinical and financial outcomes

Direct oversight of project management resources for execution

Managing and prioritizing portfolios at an aggregate level and rebalancing needs

Developing actionable contingency plans and triggers

Demonstrated ability to run large scale, highly visible programs and to orchestrate the efforts of cross-functional colleagues in key projects, and in an environment of tight deadlines.

Role Desirables

Master's degree

Knowledge of the pre-authorization process

Additional Information

Humana is an organization with careers that change lives-including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com