Regional VP (COO) Medicaid-WI

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Humana is a Fortune 40 market leader in integrated healthcare whose dream is to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana starts from within, and is committed to providing progressive benefits that advance 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.

Humana’s Wisconsin Medicaid Regional VP, Market Operations (COO) will be responsible for the strategic development and oversight of operations for Humana’s Wisconsin Medicaid and Long-Term Care plan and will be directly accountable for operational results in those areas. This role requires an in-depth understanding of how organization capabilities interrelate across segments and or enterprise wide. He/she will manage ongoing operations across multiple levels of the organization to meet operational contract requirements and financial performance goals.

The Regional VP, Market Operations (COO) works with various groups such as Risk Management, Quality, Network, Member & Provider Services, Clinical, Analytics and Sales internally, and Providers/Hospitals/Ancillary externally. This person will be expected to drive optimization thru strategic planning and addressing specific business performance issues across matrixed organization and fostering key relationships with business stakeholders. Decisions are typically related to intradepartmental coordination, development and implementation of strategic plans, and business outcomes.

The Regional VP, Market Operations (COO) will report directly to our Wisconsin Regional President.

Key Responsibilities

• Designs, coordinates, and completes operational improvement projects across various functional areas within Humana to improve services, manage ongoing adherence to local, state, and federal regulatory and programmatic requirements.
• Manages daily operational of multiple levels of staff and multiple functions/departments across Humana to review and improve operational functions to ensure the execution of daily operating objectives and goals, including key performance metrics.
• Collaborates with the plan CEO and Executive Team on strategy and business planning to achieve business goals and maximize financial and customer performance.
• Leads Operations, plus matrix responsibility for other functional teams including but not limited to Billing and enrollment, Claims, Encounter Reporting, Payment Integrity, Member Call Center, Provider Call Center, Provider Data Operations, and IT.
• Supports the development and execution of strategies to maximize growth, member retention, innovation, and member/provider experience for all products (Medicaid and Long-Term Care (LTC)).
• Owns business analysis and successful implementation of new contractual requirements.
• Partners with Contract Manager and Compliance Officer to manage process for timely and accurate regulatory reporting (non-financial) and updates to the Wisconsin Department of Health Services (DHS).
• Identifies and implements performance opportunities including those to improvement Member experience and Provider experience, efficiency, and accuracy.
• Informs and advises management regarding State current trends, and problems and activities to facilitate both short and long-range strategic plans to improve operational performance and enhance growth.
• Provides strategic leadership of provider network strategy to drive growth and performance, including oversight of Value Based Provider programs and MSO relationships.
• Delivers value to members by optimizing the member experience and maximizing new member growth and retention.
• Embeds health equity in all strategies involving member, provider, and community.
• Leads change and innovation by demonstrating emotional resilience managing change by proactively communicating the case for change and promoting a culture that thrives on change.
• Develops and cultivates a diverse and inclusive environment.
• Builds, leads, and develops a team of 15+ associates: coach and mentor associates with a goal of developing and retaining talent.

Use your skills to make an impact

Required Qualifications

• Must reside in the state of Wisconsin.
• Bachelor’s degree in business, Operations Management, Healthcare Administration, or a related field.
• Must have Long Term Care (LTC) experience
• Knowledge of and experience related to publicly funded government health care programs (e.g., Medicaid, Long-Term Care (LTC) or State health care programs for the uninsured).
• 8+ years working in healthcare operations and/or oversight of health plan management, including several years working in a matrix environment.
• Deep technical and financial understanding of health plan operations, particularly Medicaid.
• 5+ years leading teams preferably of at least 5 direct reports, with proven success in expanding and elevating the capabilities and performance of the team.
• Working knowledge of relevant federal and state regulations and requirements pertaining to Medicaid and Long-Term Care.
• Advanced analytical and problem-solving skills.
• Ability to lead and manage special projects that may necessitate cross-functional partnerships.
• Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences.
• 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.

Preferred Qualifications

• Master’s degree in business, Healthcare, Public Health, or related field would be ideal.
• Reside in Madison or Milwaukee area

Additional Information

• Workstyle: Hybrid
• Travel: up to 40% to Humana’s office locations and external agencies in the state of Wisconsin.

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.

$203,400 - $279,800 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

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 at Humana.com and at CenterWell.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.