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Greater Peoria, IL

Director of Utilization Management (UM) Cost of Care Strategy



Kentucky, USA · Remote
Posted on Tuesday, July 2, 2024

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The Director of Utilization Management (UM) Cost of Care Strategy provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Director of Utilization Management (UM) Cost of Care Strategy requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Director of Utilization Management (UM) Cost of Care Strategy plays an important role within utilization management at Humana to define, prioritize and execute on our key strategic priorities to drive appropriate care in order to improve cost of care and clinical outcomes; identify efficiencies; and improve experiences across members, associates and providers. You are driven by the opportunity to use your strong strategic and analytical acumen to drive impact and create significant measurable value. You are passionate about collaboration and partnering across the enterprise (e.g., Clinical Operations, Markets, Care Management, Clinical Strategy, Analytics, Pharmacy, Advocacy, etc.) to develop pragmatic, high value strategies and drive exceptional operational execution of our key objectives. You are curious – you enjoy connecting the dots between business metrics and frontline, understanding key root causes for what we see in data, testing hypotheses for what we could improve to drive value, and transforming ideas into action.

You will provide pivotal leadership integral to Humana achieving its vision to reimagine utilization management and drive transformative change in the coming 3-5 years, resulting in positive impact for providers, members, industry & legislative stakeholders, as well as Humana.


Strategy and scoping:

  • Conduct multi-pronged discovery on utilization management at Humana – past approaches & learnings at Humana, current initiatives & challenges, current & future industry dynamics, competitive landscape, etc.
  • Develop learning agendas and partner with analytical functions to rigorously study UM trends and outcomes, and leverage data and insight to continuously improve program outcomes
  • Assess where to play (e.g., highest value opportunity spaces) and how to win (e.g., tactics and capability requirements for opportunity capture) – develop strategic framework, conduct relevant quantitative analyses and feasibility assessments to prioritize highest value strategic initiatives
  • Collaborate with key partners across enterprise to co-develop strategies / priorities – working hand-in-hand with Clinical Operations and Market partners, ensuring connectivity into broader enterprise strategies and with broader clinical assets (such as Care Management and Pharmacy), informing strategies with data-driven insights from Analytics, Health Care Economics
    • Provide day-to-day leadership to drive progress and alignment
    • Solicit senior leader alignment on key decisions through executive-level presentations and discussion facilitation

Initiative planning, implementation, operating model:

  • Translate strategies into OKRs and tactical implementation plans for execution, in collaboration with key partners / stakeholders (e.g., technology, operational teams, provider experience, etc.); ensure joint prioritization of key operational imperatives
  • Provide leadership on defining & executing on relevant governance forums to support excellent operational execution & capability development
    • E.g., Stand-up or integrate into existing relevant governance forums to align on key decisions, track progress, escalate issues, and solicit support for operational execution of strategy
    • E.g., Develop & execute process to ensure appropriate stakeholders have had opportunity to inform, decide or veto key decisions
    • E.g., Determine key metrics and progress milestones to track against
    • E.g., Provide day-to-day leadership to drive progress and alignment

This is a remote position.


Use your skills to make an impact

Required Qualifications

  • Bachelor’s degree or higher
  • 3-5+ years in management consulting, corporate strategy, business operations or equivalent experience in healthcare company
  • Prior experience in healthcare industry and project leadership
  • Team leadership experience as a people leader role will have individual contributors reporting into it
  • Proven organization, planning and prioritization skills to collaborate with multiple internal stakeholders concurrently (and potential also vendor partners); ability to operate on deadlines
  • Demonstrated analytic acumen, ability to leverage data to drive decision making and improve outcomes
  • Strong strategic acumen with focus on continuously improving outcomes and customer experience
  • Excellent executive-level communication skills and presentation skills, including developing compelling stories for executive audiences
  • Comprehensive knowledge of all Microsoft Office applications including Excel, PowerPoint, Word

Preferred Qualifications

  • Deep understanding of Utilization Management
  • Deep understanding of Humana teams and enterprise interconnectedness

Additional Information

Work-At-Home Requirements

  • 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

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

Scheduled Weekly Hours


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.

$164,700 - $226,600 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.

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.