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
• Cross-Functional Collaboration with Key Stakeholders
• Compliance and Quality Improvement
• Vendor / Pilot Program Evaluation and Monitoring

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

Collaborate with cross-functional teams and internal stakeholders to ensure alignment of clinical strategies with regional executive leadership. Serve as a clinical liaison to the provider engagement team to ensure consistent execution of initiatives. Serve as a clinical liaison for provider partners regarding utilization management operations questions, interfacing with central UM team. Collaborate with the delegation team to identify and resolve performance issues or access concerns.

Compliance and Quality Improvement

Support regional leadership in maintaining compliance with clinical best practices and regulatory standards. Participate in continuous quality improvement initiatives, including root cause analysis, best practices to close care gaps.

Vendor / Pilot Program Evaluation and Monitoring

Coordinate the implementation of clinical vendor programs across the region, ensuring operational readiness, provider education, and ongoing support for seamless integration. Assist in the evaluation of clinical program pilots and vendor supported initiatives through analysis and monitoring of key performance indicators. Track vendor performance metrics and collaborate with finance team to prepare performance reports to support data-driven decision making and support a ROI. Provide insights to inform program scalability and effectiveness.

Required Qualifications

Bachelor's degree in a science or health-related field. Minimum of 5 years of experience in the healthcare industry. Minimum 3 years of experience in data analytics, clinical operations, care management, quality improvement, or vendor oversight. Proficient in analyzing and representing data using tools visualization tools (e.g., Excel, Tableau, Power BI) and interpreting it for various audiences. Strong understanding of value-based care, population health, and clinical quality metrics. Experience managing or supporting third-party vendor relationships in a healthcare setting. Excellent organizational, communication, and problem-solving skills. Proven ability to provide high-quality, responsive service to internal and external stakeholders. Demonstrated ability to lead through influence and collaborate across teams. Thrive in a remote work environment with independent work skills. Travel expected 5-15%.

Preferred Qualifications

Advanced Degree (such as MSN, MBA, MHA, MPH). Experience in managed care, health plan operations, or Medicare Advantage programs (including various SNP products) or Managed Medicaid. Familiarity with remote monitoring, digital health tools, or clinical innovation platforms. Project management experience or certification (e.g., PMP, Lean Six Sigma).

Work-At-Home Requirements

To ensure Home or Hybrid Home / Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home / Office associates must meet the following criteria : At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home / Office associates with telephone equipment appropriate to meet the business requirements for their position / job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information 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.