Medicaid Lead, Technology Solutions
Become a part of our caring community and help us put health firstThe Lead, Technology Solutions devises an effective strategy for executing and delivering on IT business initiatives. The Lead, Technology Solutions works on problems of diverse scope and complexity ranging from moderate to substantial.
The Medicaid Lead, Technology Solutions builds strategic partnerships and manages relationships between IT and the aligned business group(s). The Lead facilitates guidance to business partners on information technology (IT) solutions, stays current on and leverages industry trends, and challenges business and IT to drive for best outcomes by leveraging the best technology solutions. This is achieved by having a clear understanding of business, its strategic direction, and targeted outcomes along with technology trends both internal and external to the organization. The role serves as the Single Point of Contact representing assigned business area(s) to the IT organization and representing Humana IT with internal business partners along with State and Federal regulators. The Lead ensures RFP responses are accurate and reflect the true and competitive capabilities Humana brings to the table, ensures internal SLAs are in place to support contracts, and technology is configured to operate within contractual obligations. The Lead drives solutions at an organizational level to provide maximum value and align to the overarching IT strategy. They measure value to demonstrate and promote the value of IT to their respective areas and the organization as a whole.
- The CIO is dedicated full-time to the Indiana Medicaid product lines.
- Builds and maintains relationships with regulators and business leaders to understand the business strategy and needs and to advocate technology solutions to deliver results.
- Stays current on relevant technologies leading efforts to match business needs with best technology solutions.
- Organize and run any one-time or recurring technology-related meetings with state personnel, and/or with the state’s technology partner
- Provide thought leadership for state regulators, Humana market leaders, and occasionally other MCOs when multi-MCO implementations are involved
- Be on point for the technology portion of all state Medicaid compliance audits. These will often tie back to the P&Ps noted here on the previous bullet.
- Collaborate with Market Operations/leadership in problem solving and help with workarounds as required to meet state deadlines that are in significant conflict with Humana IT’s development timelines.
- Serves as the “Senior Business Architect” for Medicaid, with a strong understanding of how the industry’s standard processes are executed in Humana’s environment, from end to end
- Develop and own all state-level Humana IT P&Ps, working with Humana IT compliance, the Privacy Office, and other internal areas as needed
- Participate in Command Centers or other operationally focused meetings as determined by each market
- Participate in Market President’s senior leadership meetings, as appropriate
- Ensure documentation is gathered and distributed to the appropriate market and IT peers for any state led meetings
- Accountable for monitoring contractual SLA performance for State contracts to successfully deliver and avoid potential millions in liquidated damages and maximize revenue
- Responsible for state technology roadmap including delivery of strategic imperatives to position to win and re-win contracts at renewal
- Accountable for collaborating with business and IT peers to collect, maintain and store specifications, documentation, design documents, process flows, etc. relating to the state implementation.
- Leads teams to gathers business requirements and clarify scope during initial discovery by conducting meetings/interviews, and facilitating large group/cross-functional sessions with partners
- Effectively influences key stakeholders, team members, and peers outside of direct control of this role, to deliver optimal solutions in line with the best interests and expectations of the business partner.
- Conducts executive level briefings presentations and solution recommendations
- Serve as a liaison between the Contractor and the State fiscal agent or other FSSA contractors regarding encounter claims submissions, capitation payment, member eligibility), enrollment and other data transmission interface and management issues.
- The CIO or IT Director, in close coordination with other key staff, is responsible for ensuring all program data transactions are compliant with the terms of the Contract.
- The CIO or IT Director is responsible for attendance at all Technical Meetings called by the State.
Use your skills to make an impact
Solid understanding of operations, technology, communications and processes
Possess 10+ years of progressive experience leading continuous improvement efforts, evaluating existing systems and implementing process improvements.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
***While this is a remote opportunity, it will require the willingness to travel to the market office and state office as needed***
• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Scheduled Weekly Hours40
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.