DescriptionIn alignment with our focus on integration of care, clinical excellence, and experience excellence, we are launching a search for an AVP, Healthcare Payment Innovation. This leader will have accountability for Humana’s payment innovation strategy, primarily focused on our Medicare providers and networks, but also including commercial, Medicaid and Tricare as needs emerge. He/she will also act as a thought leader representing Humana’s inventive strategies internally and externally. We’re seeking an individual who will bring a provider-centric background to this vital role– including a progressive career in payment centered efforts, network development, provider engagement and service operations, combined with current experience with ACO, Medical Home, Pay for Value and similar integrated care models built on innovative risk/reward payment strategies and best practice intents.
This AVP, Healthcare Payment Innovation role is positioned within our Retail Segment, and more specifically within the Strategic Innovation. This is a newer and small group of leaders who are accountable for connecting the organization to drive innovation and new trend bender value across the Retail segment. The Payment Innovation Vice President will report to the SVP, Strategic Innovation, and will have responsibility for 1-3 or more direct reports. Ideally, this role will be based within the “epicenter” of Humana’s corporate infrastructure, (Louisville, KY) providing regular opportunities for engaging and developing relationships with our leaders and other corporate executives who define the strategic vision and culture of Humana.
Key Role Objectives/Responsibilities
- Develop comprehensive knowledge of Humana, including the interdependent service-driven relationships within the Retail, Services and Commercial segments.
- Conduct a thorough internal and external assessment of payment innovations including CMS, competitors, risks, and expansion opportunities; develop a Payment Innovation “Resource Hub” which collects/stores/shares the industry’s best examples of current and evolving payment innovations and models.
- Create a cross-functional governance team to help drive prioritization of payment innovations; Influence Senior Leadership to adopt new ideas, products and / or approaches and gain commitment on cross-segment initiatives
- Assume responsibility for leading the Payment Innovation Team, including the development and execution of provider payment innovation strategies for the company across all business segments.
- Collaborate and strategize with other industry leaders and providers on new ideas and methods.
- Serve as an internal and external “thought leader” for Payment Innovation, creating educational resources and delivering presentations which highlight advancement and successful ROI in this space, including the regular interpretation and sharing of new industry developments and the competitive environment.
- Work cross functionally, aligning with Actuarial, Clinical Quality, Medical Management, National Contracting, Provider Engagement, Health Guidance, Market Operations, Primary Care entities and other stakeholders to develop and execute on Payment Innovation pilots.
- Design and develop provider metrics and capabilities related to payment innovation programming, including economic benchmarks and milestones for success.
- Upon execution of successful pilots, transition programs to the Provider Development team for scaling broadly.
- Ensure a healthy pipeline of Top 3-5 priorities at any given point in time.
- Ensure successful execution of attracting, developing, motivating, and retaining organizational talent; Build and sustain team synergy while maintaining accountability for results.
- Promote professional development of strategy team members; enhance their skills and capabilities through project work and one-to-one coaching
- Support the corporate planning process and ad hoc projects for executives, corporate requests, and special events.
Our Ideal Candidate
The successful candidate will bring 10 or more years of managed care leadership experience to this role with progressive leadership of provider risk contracting, network development and operations. Prior responsibility for developing and executing on value-based payment strategies and leading operations within an ACO (or similar) model is required.
- Medicare and/or commercial managed care experience is essential to success in this role; multi-state experience preferred.
- Comprehensive knowledge of health plan finance and the compensation arrangements between health plans and providers.
- References who will speak to leadership competencies, collaboration, emotional intelligence and other Humana “cultural fit” requirements for our executive leaders.
- Broad experience within a corporate matrix environment, with regular interface to centralized and field-based operational/business development functions (finance, network/contracting, medical management, sales, service, etc.) Demonstrated ability to partner across functions to create/deploy win/win strategies.
- Prior experience developing consultative business relationships with executive leaders in ACO (or similar) models, including the ability to analyze/interpret complex clinical data and use “outcomes” to influence commitment/action to engage innovative strategies.
- Competencies in public speaking, project management and change management.
- Skill in driving results, thinking strategically and executing strategy effectively; thinking at an enterprise level.
- Commitment to recruiting/developing diverse talent to meet the dynamic business requirements of the market.
- Bachelor’s degree in Health Care Administration, Finance or related field required; MBA preferred.
- Travel flexibility (30-40%) to successfully execute the requirements of this role.
Scheduled Weekly Hours40