• Job Description

  Req#: R-410114

  Become a part of our caring community and help us put health first
  

  The Medicaid Capture Lead - Clinical and Population will lead initiatives to develop and execute operating models and strategies to successfully position Humana to capture growth opportunities. This role will work horizontally across the organization, coordinating with Medicaid leadership and population health and clinical subject matter experts to synthesize, assess, and translate state Medicaid and integrated dual eligible program requirements into actionable go-to-market strategy. Reporting to the Strategy Execution/Advancement Principal you will consult with growth partners to design and optimize population health and clinical operating model blueprints for viable Medicaid health plans that meet the needs of state clients and populations served in target growth markets.

  You will possess Medicaid managed care business development and operations expertise and have experience in designing solutions for key Medicaid programs and subpopulations. Areas of focus include Population Health, Social Determinants of Health, Health Equity, Care Management/Coordination, Quality Improvement, Behavioral Health, Interoperability, Long-Term Services and Supports, Home and Community Based Services, and Medicaid and Medicare Integration.

  Key responsibilities include:

  o Research and assess prospective Medicaid growth markets. Gather key information on market and regulatory landscape and translate federal and state policy to discern impacts to Humana’s clinical operating model.

  o Lead cross-functional teams of growth partners and health plan leaders to design high-impact, innovative, and competitive population health and clinical programs, models, partnerships, and initiatives for upcoming growth opportunities.

  o Coordinate operational teams to translate state contract requirements, CMS regulations, market intelligence, and industry best practices into a viable target operating model.

  o Develop project plans and roadmaps, driving timely completion of deliverables by cross-functional project team.

  o Track project status and report on progress to leadership.

  o Participate in the proposal development process. Provide content and recommendations to help shape responses to state Medicaid procurements and clearly articulate Humana's model.

  o Document and clearly communicate operating model features to relevant teams to support proposal development and transition to implementation.

  
  Use your skills to make an impact
  

  Required Qualifications

  o Bachelor’s Degree

  o 5+ years’ experience in a Medicaid Managed Care Organization or 5+ years’ experience in strategy consulting supporting Medicaid clinical strategy, population health management, or business development.

  o Experience and understanding of the Medicaid ecosystem and managed care health services operations.

  o Business development/proposal and/or implementation experience within Medicaid Managed care.

  o Experience leading cross-functional teams to design a strategy and/or product.

  o Strong problem-solving ability (i.e. adept at research and generating creative solutions)

  o Ability to operate in a fast-paced environment under tight deadlines and in ambiguous situations.

  o Highly organized and analytical with a strong attention to detail.

  o Advanced Proficiency in Microsoft Office Products (i.e. Word, Excel, PowerPoint, Visio).

  o Adept at quantitative and qualitative research.

  o Excellent verbal and written communication and presentation skills.

  Preferred Qualifications

  o Master’s Degree in Public Health, Social Work, or Health Administration programs.

  o MBA programs with a specialization in Healthcare Management.

  o Project Management and Process Improvement qualifications.

  Additional Information

  Travel: Anticipate up to 10%

  (as defined by tri-annual onsite Leadership and/or Team meetings)

  Work at Home Criteria

  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:

  • We recommend at minimum a download speed of 25 Mbps and an upload speed of 10 Mbps; we suggest a wireless, wired cable or DSL connection.
  • Leadership approves satellite, cellular and microwave connection only if it uses them.
  • We will provide employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

  Interview Format

  As part of our hiring process for this opportunity, we will use an interviewing technology called HireVue to enhance our hiring. HireVue allows us to quickly connect and gain valuable information from you about your relevant experience at a time that is best for your schedule.

  Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

  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.

  
  

  $115,200 - $158,400 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.

  Application Deadline: 03-23-2026

  
  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 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.

• About the company

  Humana looks at every facet of your life and works with you to create a path to health that fits your unique needs

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