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Humana is a $100 billion (Fortune 42) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.

Against that backdrop, we are seeking a talented executive to join the Healthcare Quality Reporting and Improvement (HQRI) organization as Senior Vice President (SVP), Risk Adjustment Operations and Interoperability. This key leadership position plays a crucial role in leading and driving strategic initiatives to optimize risk adjustment and interoperability solutions that deliver quality outcomes and business value. This role will impact our overall Medicare and Medicaid strategy, as it directly impacts the revenue needed to fund benefits.

The SVP will create and own the vision, mission, and strategic plan for enterprise risk adjustment and interoperability, both of which are key strategic priorities for Humana. This will directly impact the experience of 5.5 million members impacted by interoperability, including 600,000 providers connected to interoperability solutions and 730+ hospitals across 100+ health systems on payer platforms.

The SVP will report directly to the SVP, HQRI and lead a multi-level organization of more than 500 associates, with approximately 7 direct reports, and will manage an administrative budget of roughly $100 million. This position can be located anywhere within the contiguous United States, although a major city in the Eastern U.S. would be ideal. Moderate travel (20%) should be expected.

Key Responsibilities

Sets the vision and strategic plan for risk adjustment for the enterprise and oversees all operations within Risk Adjustment, including but not limited to:

• Medical Record Retrieval for all Medicare, Medicaid and Commercial Risk

• Adjustment functions (retrospective review and all compliance and audit processes) and HEDIS

• Coding Operations for Medicare and Commercial Risk Adjustment

• Encounter submissions to work errors in encounter submissions

• Dual Eligible Outreach team

• Oversight and support of all Market MRA functions

• Policies, procedures, training, and education for all risk adjustment functions

Ensures integration of risk adjustment functions across corporate, market teams and internal and external partners

Leads the compliance function of risk adjustment. Provides strategic insight and oversight of key regulations and guidance, partners with Corporate Affairs on proposed and final rules and legislation, support regulation impacts to existing programs and helps to ensure any new program changes are implemented with changing regulatory landscape.

Develops the vision and strategic plan for interoperability for the enterprise.

Responsible for the experience of members and providers using multiple interoperability products. Helps drive the development of new interoperability use cases and the adoption of digital solutions to increase point-of-care risk adjustment and quality.

Sets the vision and strategic plan for prospective programs to drive risk adjustment and quality value. Drives the development of internal capabilities to manage program performance. Deploys test & learns including evaluation, implementation, measurement, and scalability.

Drives innovation in risk management methodologies and technologies

Owns strategic relationships and negotiates contracts with vendors as well as all internal operational partners

Serves as a key leader/support for Market Leadership, including Market MRA Directors, Presidents, and Divisional Presidents.

Leads a team of approximately 7 direct reports, including VPs, AVPs, and Directors with more than 500+ associates in the organization. Develops the talent and fosters a culture to meet and exceed results.

Use your skills to make an impact

Key Candidate Qualifications

The ideal candidate will have extensive leadership experience (typically 10+ years) in the healthcare industry, specifically in risk adjustment, operations, and interoperability with a proven track record of driving quality, financial and operational performance. He/she will have expertise in the development and execution of enterprise strategy, along with a record of success working in a highly matrixed environment. Finally, this person will be a strong leader of people with proven success in expanding and elevating the capabilities and performance of a multi-level team and large-scale organization.

In addition to the above, the following professional credentials and personal attributes are also sought:

• Bachelor's degree in healthcare administration, business, or a related field. Master's degree is highly desired.

• In-depth understanding of partners/functions within and outside the segment. Understanding of how organization capabilities interrelate across segments and enterprise-wide.

• Demonstrated ability in building strategic relationships with internal and external parties, including cross-functional partners, corporate and market functions, vendors and providers.

• Deep knowledge of the health insurance industry, competitive landscape, Medicare operations end-to-end and a keen respect for compliance and legal guidelines.

• Solid finance acumen and understanding of the compensation arrangements between health plans and providers.

• Proven ability to manage the complexity of competing priorities.

• Record of success in leading large-scale, multi-function operations organizations.

• Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences, both internally and externally.

• Current or recent experience in a large, highly matrixed company (i.e., Fortune 150), with proven ability to influence leaders and key stakeholders and achieve successful outcomes in such an environment.

• Highly collaborative mindset and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs and win their co-ownership in the outcome, particularly in scenarios that call for 'tough conversations' to be conducted.

Scheduled Weekly Hours

40

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 because he or she is a protected veteran. 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.