Principal Consultant, Medicaid Medical Economics & Cost Mgt.

Become a part of our caring community The Medical Economics Principal analyzes healthcare cost, utilization, and outcomes data to inform strategies that improve affordability and quality of care. The Medical Economics Principal provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience. At Humana, we are committed to making healthcare affordable, accessible, and high-quality. The Principal, Medicaid Medical Economics & Cost Management plays a dual role:

1. A critical leadership role responsible for translating medical economics insight into disciplined execution across clinical, behavioral health, and pharmacy cost initiatives; and
2. Leadership role overseeing the Medicaid Corporate Trend process from a business perspective partnering with Finance & Actuary.

Key Responsibilities Clinical Strategy Initiative Tracking & Project Management: Lead and track specific clinical, BH, and Rx cost management initiatives across the Medicaid portfolio. Synthesize cost, utilization, and outcomes data to drive strategic decision-making, ensure initiative execution, and supports enterprise-wide cost management and medical economics strategies. Project manage best practices to drive execution, measure progress, and ensure timely delivery. Medical Cost Management Strategy: Develop, represent, and integrate a medical cost management plan into annual and multi-year business plans. Collaborate with leaders across Clinical, Pharmacy, Network, Product, and Claims teams. Business Partnership with Finance: Act as the primary business partner to Finance, translating clinical and operational insights into actionable financial impact. Develop and enhance models, metrics, and reports for effective monitoring and communication of cost management outcomes. Data-Driven Analysis: Analyze historical, predicted, and competitive market data to recommend benchmarks and KPIs. Generate insights to guide pricing, reimbursement, and value-based care initiatives. Continuous Improvement: Research industry standards, vendor solutions, and build requirements for internal solutions. Develop new approaches to improve utilization and health outcomes, collaborating flexibly with providers and cross-functional teams. Medical Economics Trend Oversight Trend Stewardship: Lead as business accountability champion for quarterly reviews with Trend Stewardship Committee. Enterprise Accountability: Hold shared enterprise domain owners accountable for medical cost, utilization, and quality targets. Ensure alignment with Humana’s strategic objectives through robust governance and reporting processes. Stakeholder Engagement: Build strong relationships with Market Presidents, Medical Directors, Clinical Strategy, Operations, Finance, and other key stakeholders. Ensure engagement and consensus for initiative execution and performance monitoring. Reporting & Governance Reports to senior executive leadership. Supports governance forums and committees (e.g., Trend Stewardship Committee). Ensures all work adheres to Humana’s compliance, data stewardship, and security standards. Use your skills to make an impact Required Qualifications Bachelor’s degree in Economics, Statistics, Public Health, Healthcare Administration, or related field. 10+ years of healthcare industry experience (payer, medical economics, analytics, cost management, or related). Demonstrated experience leading cross-functional teams and executing complex, large-scale transformation initiatives. Advanced analytic acumen; proficiency in Excel and data visualization tools. Strong understanding of healthcare reimbursement models, managed care, and principles of medical cost management . Proven organizational, planning, and prioritization skills. Highly collaborative mindset, with excellent stakeholder engagement and executive-level communication skills. Ability to synthesize data into actionable business insights and drive measurable improvements. Preferred Qualifications MBA, Master’s degree. Experience with Humana’s organizational structure, key business domains, and data assets. Additional Information Schedule/Time Zone: Monday–Friday, 8:30 AM–5:00 PM ET Work Location: United States (Nationwide) Work Style: Remote Travel Requirements: Up to 20–25% Work at Home Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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. $142,300 - $195,700 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 07-22-2026 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com. 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 #J-18808-Ljbffr Humana Inc