Clinical Investigation Lead - Humana
Springfield, IL
About the Job
Become a part of our caring community and help us put health first
The Clinical Strategy Team is a multi-disciplinary team focused on using advanced analytics techniques and clinical acumen to identify clinical strategies to improve experiences for our members and providers, all while driving health outcomes and cost-effective care for our members. We are seeking a Clinical Investigation Lead to provide strategic direction to drive appropriate care, with the aim of reducing waste and overuse of healthcare services, while encouraging high value care. The team synthesizes clinical insight, analytic acumen, and operational insights to bring forth a pipeline of potential initiatives.
Location: remote
In this lead role you’ll have the opportunity to analyze complex business and clinical issues leveraging healthcare and operational data to support healthcare utilization investigations, while working collaboratively with clinicians, data scientists, actuaries, subject matter experts, and business owners across Humana to drive solutions forward. In this role you will lead quantitative and qualitative investigations to identify actionable insights and bring the insights to action through cross-organizational collaboration.
Key responsibilities
+ Support enterprise-wide initiatives to address healthcare waste and inappropriate care to ultimately positively impact medical costs, improve the member experience, and enhance health outcomes.
+ Support collaboration with cross-functional partners (e.g., clinicians, analysts/data scientists, clinical SMEs/leaders, business partners) to investigate early indicators of inappropriate spend and identify clinical opportunities.
+ Generate actionable business insights through detailed investigations leveraging analytics, research, and clinical acumen to enable a pipeline of initiatives that will positively impact Humana’s member experience, health outcomes and costs.
+ Lead project workgroups with operational teams & enterprise partners to vet and implement prioritized solutions.
+ Produce high quality presentations and reports, to be shared with diverse stakeholders.
This role would be a great fit if:
+ You are passionate about ensuring high value care - you’re motivated by driving positive health outcomes for members and reducing waste in the healthcare system.
+ You are driven – you’re eager to use your strong strategic and analytical acumen to drive impact and create significant measurable value.
+ You are collaborative - you like partnering across the enterprise to develop.
+ You are curious - you enjoy synthesizing insights from a variety of clinical, analytic, and operational sources.
Use your skills to make an impact
Role Essentials
+ 7+ years of experience in clinical strategy and/or HealthPlan operations
+ Professional clinical license (e.g., MD, Registered Nurse or Pharmacist) or advanced degree such as Masters degree or higher in Epidemiology or Public Health
+ Experience in medical cost opportunity identification to improve evidence based clinical care
+ Expertise in critically reviewing & synthesizing recommendations and insights from clinical society guideline and literature
+ Experience working with multi-disciplinary teams (e.g., data scientists/analysts, actuaries, clinicians, operational leaders, etc.), with evidence of deep understanding of healthcare data and health-systems operations
+ Excellent written and verbal communication skills, with ability to present complex information to senior-level audiences
+ Strong analytic and trend skills.
+ Proven ability to work collaboratively across teams and stakeholders
+ Engage in ambiguous problem solving and strategy setting
+ High learning acuity and ability to navigate rapidly changing situations and business priorities
Role Desirables
+ Demonstrated experience working with healthcare claims data sets, including medical coding and medical claims.
+ Experience with how utilization management (UM) and regulatory guidance can influence clinical strategies.
+ Highly creative and able to think “outside the box"
Additional Information
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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.
$112,400 - $154,900 per year
This 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
The Clinical Strategy Team is a multi-disciplinary team focused on using advanced analytics techniques and clinical acumen to identify clinical strategies to improve experiences for our members and providers, all while driving health outcomes and cost-effective care for our members. We are seeking a Clinical Investigation Lead to provide strategic direction to drive appropriate care, with the aim of reducing waste and overuse of healthcare services, while encouraging high value care. The team synthesizes clinical insight, analytic acumen, and operational insights to bring forth a pipeline of potential initiatives.
Location: remote
In this lead role you’ll have the opportunity to analyze complex business and clinical issues leveraging healthcare and operational data to support healthcare utilization investigations, while working collaboratively with clinicians, data scientists, actuaries, subject matter experts, and business owners across Humana to drive solutions forward. In this role you will lead quantitative and qualitative investigations to identify actionable insights and bring the insights to action through cross-organizational collaboration.
Key responsibilities
+ Support enterprise-wide initiatives to address healthcare waste and inappropriate care to ultimately positively impact medical costs, improve the member experience, and enhance health outcomes.
+ Support collaboration with cross-functional partners (e.g., clinicians, analysts/data scientists, clinical SMEs/leaders, business partners) to investigate early indicators of inappropriate spend and identify clinical opportunities.
+ Generate actionable business insights through detailed investigations leveraging analytics, research, and clinical acumen to enable a pipeline of initiatives that will positively impact Humana’s member experience, health outcomes and costs.
+ Lead project workgroups with operational teams & enterprise partners to vet and implement prioritized solutions.
+ Produce high quality presentations and reports, to be shared with diverse stakeholders.
This role would be a great fit if:
+ You are passionate about ensuring high value care - you’re motivated by driving positive health outcomes for members and reducing waste in the healthcare system.
+ You are driven – you’re eager to use your strong strategic and analytical acumen to drive impact and create significant measurable value.
+ You are collaborative - you like partnering across the enterprise to develop.
+ You are curious - you enjoy synthesizing insights from a variety of clinical, analytic, and operational sources.
Use your skills to make an impact
Role Essentials
+ 7+ years of experience in clinical strategy and/or HealthPlan operations
+ Professional clinical license (e.g., MD, Registered Nurse or Pharmacist) or advanced degree such as Masters degree or higher in Epidemiology or Public Health
+ Experience in medical cost opportunity identification to improve evidence based clinical care
+ Expertise in critically reviewing & synthesizing recommendations and insights from clinical society guideline and literature
+ Experience working with multi-disciplinary teams (e.g., data scientists/analysts, actuaries, clinicians, operational leaders, etc.), with evidence of deep understanding of healthcare data and health-systems operations
+ Excellent written and verbal communication skills, with ability to present complex information to senior-level audiences
+ Strong analytic and trend skills.
+ Proven ability to work collaboratively across teams and stakeholders
+ Engage in ambiguous problem solving and strategy setting
+ High learning acuity and ability to navigate rapidly changing situations and business priorities
Role Desirables
+ Demonstrated experience working with healthcare claims data sets, including medical coding and medical claims.
+ Experience with how utilization management (UM) and regulatory guidance can influence clinical strategies.
+ Highly creative and able to think “outside the box"
Additional Information
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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.
$112,400 - $154,900 per year
This 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana