Clinical Business Lead

Clinical Business Lead

Become a part of our caring community and help us put health first. The Clinical Business Lead works on problems of diverse scope and complexity ranging from moderate to substantial. As Regional Clinical Advisor, you serve as a key member of the regional clinical team responsible for supporting data-driven clinical strategy, performance monitoring, and continuous quality improvement within the Medicare Advantage program to support improving the health of members. The Clinical Advisor requires close collaboration with regional leadership and cross-functional teams to ensure alignment with initiatives to drive improved member health outcomes. The Clinical Advisor plays a key role in advancing regional clinical strategy by working directly with the Regional Vice President of Health Services (RVP) and Health Services Director (HSD). This position focuses on enabling connections with providers, supporting innovation initiatives, implementing clinical programs, managing vendor relationships, and contributing to performance management and governance / delegation oversight.

Primary Responsibilities :

Data Analytics to Support Clinical Strategy, Performance Reporting, and Monitoring :

• Analyze chronic condition performance so regional clinical leadership can bring insights to provider groups to drive awareness, education and action plans.
• Evaluate the effectiveness of clinical program initiatives through analysis of the downstream impact of such initiatives on facility and provider performance in value-based programs.
• Identify opportunities for new clinical program initiatives by assessing cost and utilization drivers, inclusive of a chronic condition focus.
• Support facility case review discussions with pre-meeting analysis of submitted case reviews as needed.
• Prepare data and evaluate performance to support RVP and HSD in governance and delegation oversight committee and interact with the corporate delegation compliance and auditing teams.

Cross-Functional Collaboration with Key Stakeholders :

Compliance and Quality Improvement :

Vendor / Pilot Program Evaluation and Monitoring :

Use your skills to make an impact

Required Qualifications :

Preferred Qualifications :

Work-At-Home Requirements :

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. $104,000 - $143,000 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 : 11-13-2025

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. 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.