Humana

About Humana

 

Job Category:

Enterprise Development - Strategy

Country:

United States

Postal Code:

40201

Approximate Salary:

Not Specified

Position Type:

Full time

Director–Provider Trend Ideation, Development, Quantification Management (Nationwide)

Humana - Louisville, Kentucky

Posted: 08/9/2018

Description

This role concentrates on all Hospital, Physician & Ancillary-related Network & Contracting trend issues, opportunities and initiatives. The focus is national, but includes direct interaction with all Humana Medicare and Commercial markets (including Divisional Presidents, Market Presidents, Regional Vice Presidents of Provider Engagement and Market Finance Leaders). Strong knowledge of provider partnership arrangements, Humana’s networks, health care industry approaches to understanding and measuring trend, and expertise on unit cost and case mix factors that influence trend are at the heart of this role. The ability to understand both internal and external sources of trend drivers, how to measure and anticipate potential increase areas, and then how to design contemporary approaches to addressing trends so that Humana can focus (from a provider perspective) on trend bender/savings opportunities, is a primary objective.

Responsibilities

This Director will work closely with the market leadership teams referenced above as well as Corporate (Medicare Advantage, Commercial, and Medicaid) leadership to communicate trend activities, trend ideation, trend bender initiatives and management and tracking of results for trend bender initiatives. The Director will be a close partner with other team members in the Provider Analytics and National Contracting organizations.

The Director of Provider Trend Ideation, Development, Quantification & Management will lead a team of associates and will report directly to the Vice President of Provider Analytics.  The position will work closely with many associates at Humana’s headquarters in Louisville, but it is not necessary to live in Louisville to be successful in this role.
 

KEY RESPONSIBILITIES:

  • A strong grasp on hospital, physician and ancillary-related trend drivers for health care payers, the health care industry, provider health systems, and CMS (including a grasp on direction that MEDPAC believes the industry is heading).  Use this information for tracking of trend variation, including developing predictions around where trends may be increasing and ideating solutions to mitigate those trend changes (trend bender directives for Humana).
     
  • Working with both the markets and corporate, as well as others from the Network and related teams, develop trend bender solutions that not only save costs for Humana, but at the same time are beneficial for both members and Humana’s hospital/physician/ancillary partners.  Being able to develop “win/win/win” solutions, involving strong collaboration skills and understanding the perspective of all the players, is critical in this role.
     
  • Understand business strategy at the Corporate, National and Market levels such that any trend bender related solutions are in line with provider and overall business strategies at Humana.
     
  • Understand best in class technology solutions and where applicable, incorporate those into trend ideation, measurement, prediction, and tracking. 
     
  • Create dashboards and metrics for benchmarks, determine milestones for success, and provide periodic updates on trend bender activity and ongoing results.
     
  • Coordinate with Provider Analytic departmental peers, Market Leadership, and Corporate teams across the enterprise to ensure collaboration, transparency, and alignment on various trend bender initiatives.
     
  • Understand the competitive environment, best practices, education and then communicate approaches to ensure all parties at Humana are on board with trend bender initiatives and aware of actions and implications. 

KEY COMPETENCIES:

Acts Strategically:  Makes decisions and sets strategy based on the long-term vision, uses an enterprise-wide perspective to translate strategies into actions, inspires others to embrace and advance the strategy, and creates a clear view of the future state.

Collaborates:  Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana’s overall success first.

Leads Change:  Guides and energizes others, models adaptability, and inspires strong organizational performance through periods of transformation, ambiguity, and complexity.

Leads Positively:  Leads by example to cultivate the climate of motivation, positive energy, and meaning in work.  Assesses, selects, recognizes, develops and empowers diverse talent.

               

Required Qualifications

  • Bachelor’s Degree in Business Administration or related
  • Prior experience and knowledge with CMS, MedPAC and/or related trend influencing organizations
  • Prior experience working in a healthcare related organization with direct knowledge and hands-on expertise around hospital, physician, and/or ancillary contracts, trend, unit cost implications, and supporting analytics
  • Strong oral presentation and organizational skills

Preferred Qualifications

  • Masters’ Degree in Business Administration, Healthcare, Analytics or related; and/or Fellow of the Society of Actuaries designation (preferred)
  • Prior experience in procuring best in class technology solutions; having led a team of analytics professionals

Scheduled Weekly Hours

40

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