Director of Medicaid Clinical Vendor Program Delivery

Profile

Description

The Director, Vendor Management - Medicaid Director of Clinical Vendor Program Delivery works as the clinical business owner for vendor capabilities, products, innovative partnerships and services. The Director, Vendor Management requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Responsibilities

As Humana's Medicaid membership continues to grow, the National Medicaid Clinical Operations team is expanding our shared services organization to deliver new clinical capabilities and products across Medicaid. The Medicaid Director of Clinical Vendor Oversight investigates clinical capability opportunities and develops solutions to problems during the design and planning phases. May be responsible for feasibility studies, pilot management with vendors, identifying and defining clinical requirements and engaging with customers to understand market needs and trends. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes with vendors, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy. Executes on Medicaid Clinical Strategy and defines Operational requirements; develops and implements vended capabilities in collaboration with cross-functional stakeholders; directs oversight of capability outcomes and analysis of products; and supports implementation of National Clinical Product capabilities in new Medicaid markets.

Detailed Job Responsibilities include:

Leads Clinical Operations in identifying and delivering Medicaid services and products to address strategic initiatives;

Directs operational process delivery for National clinical vendor partnerships;

Identifies clinical partnerships, capabilities, and vended solutions to support industry-leading capabilities for Medicaid population;

Works closely with Medicaid Business Development, National and Medicaid Market Operational leaders, and Vendor Contracting team to identify clinical products and solutions;

Determines detailed business requirements, operational workflows, business area reporting, service level standards, and processes; works with vendors and internal partners to implement and support delivery of products and services;

Collaborates with Population Health Strategy team, Analytics, and Quality teams to establish reporting requirements, measures of success, and test pilot assumptions;

Leads operational clinical vendor implementations, provides oversight of effectiveness studies and recommends program changes needed to optimize health outcomes;

Works closely with Vendor Management team to procure contracts and oversee vendor relationships;

Communicates product outcomes to stakeholders and recommends National approach for scaling to new markets where appropriate;

Serves as a Subject Matter Expert for competitive, industry-leading products and services for supporting a Medicaid Population Health strategy;

Directs team of Clinical Vendor Oversight Managers in supporting program execution and delivery of services.

Monitors and supports ongoing decision making around scaling clinical solutions across Medicaid markets.

Key Qualifications:

Master's Degree strongly preferred in Clinical or Business-related field; or Bachelor's Degree with 3 years implementing/overseeing Clinical products required ;

Clinical Background required ; clinical licensure is highly desirable ;

Medicaid experience required

7 years of Clinical Product Management, Clinical Vendor Management, or Innovation experience required

7 of Managed Care Leadership experience required

5 years of leading large scale projects and/or national implementations required

7 years developing and leading collaborative partnerships with enterprise cross-functional teams and external partners required

Background in Client Success or Vendor Account Management experience highly desirable

Recent knowledge of Behavioral Health products, innovations, and services is highly desirable

Certification with Six Sigma and/or the Project or Product Management certification highly desired

Demonstrated experience and recommendations from peers as a customer-focused, team player, with collaborative approach to leading is required

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com