Utilization Management UM Clinical Business Lead

Profile

Description

The Clinical Business Lead works as liaison between vendors and organization. The Business Clinical Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

Location: preference is Office base in Louisville, willing to consider out of state work from home

The Utilization Management (UM) Clinical Business Lead oversees the UM vendor operational services and works as a liaison between vendors and multiple departments within the organization. The Clinical Business Lead will report directly to Director of Vendor Management and Oversight team, supporting, developing, and implementing the enterprise vendor services. The Clinical Business Lead will drive cost savings, facilitate negotiations, implement contracts/new programs, and drive successful vendor relationships. This leader will also partner with leadership in Humana's business segments to drive enterprise-wide value for the UM vendor programs.

This leader is responsible for ensuring strong alignment with, and becoming a trusted advisor to, key functional leaders across the organization and works on problems of diverse scope and complexity ranging from moderate to substantial.

The Clinical Business Lead will oversee a $70M budget. Reviews and negotiates terms of vendor contracts and communicates with vendors regarding day-to-day matters. Influences vendors and stakeholders decisions. Ensure vendor's programs are performing and producing savings and ROI for the company. Builds and maintains positive relationship with vendors and stakeholders.

The leader will oversee a team of individuals who manage a large vendor accounts. Job responsibilities include:


Develop and manage team of 2-3 Sr. Vendor Managers.
Work with MDs to identify UM program opportunities.
Work with Legal, Procurement and Compliance to review and negotiate terms of the contract and designs pricing proposals.
Develops and delivers to Sr. Leadership vendor's operational and financial performance metrics, and opportunities for all LOBs.
Builds and maintains positive relationship with vendors, stakeholders and implements strategic plans to drive goals and objectives to improve performance.
Manage a multi-million-dollar budget ensuring established budget goals are met.
Responds to escalated complaints and resolves issues affecting provider/member or operational performance.
Maximizes vendors UM products and/or services to supports all LOBs nationally including new product launch activities to achieve revenue targets.
Exercises independent judgment and decision making on complex issues requiring analysis of variable factors and determining the best course of action.
Travel will be 10% once Covid restrictions are lifted


Required Qualifications


BSN degree
7 or more years of vendor management, operations and/or consulting experience in Healthcare Industry
3 or more years' experience leading and coaching
Demonstrated experience in negotiating terms of contracts for vended utilization management services
Outstanding communication (oral and written) and interpersonal skills, including assertiveness, and the ability to influence others
Demonstrated ability to work autonomously, both as a lead and as a part of a team
Ability to work in a team environment to collate and act upon feedback from all levels within the business and sourcing environments
Strategically oriented, resourceful, influential, critical thinker with strong problem solving skills
Ability to identify actionable insights from large data sets and translate them into strategies and secure buy-in through excellent written and verbal communication
Proficient in Microsoft Office applications including Word, Excel and PowerPoint
Must have accessibility to high speed DSL or cable modem for a home office (satellite internet service is NOT allowed for this role); and a minimum internet connection speed of 10M x 1M


Desired Qualifications


Advanced degree
Certification with Six Sigma and/or the Project Management Institute


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

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