Clinical Business Lead

Become a part of our caring community The Lead Clinical Implementation Consultant serves as the clinical subject matter expert responsible for translating utilization management requirements into consistent operational workflows and technology solutions. This role provides clinical leadership for enterprise initiatives by interpreting clinical requirements and ensuring they are accurately implemented across clinical decision support tools, electronic prior authorization, claims operations, and supporting technology platforms. Working collaboratively with Medical Directors, Referrals and Authorizations, Claims, Product, and Technology, this position ensures new clinical services, procedure codes, and utilization management requirements are implemented consistently throughout the organization while improving provider experience, operational efficiency, and clinical accuracy. Our Government Contract Requires US Citizenship for this Position The Clinical Business Lead oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. Use your skills to make an impact Required Qualifications Bachelor's degree 2 or more years of project leadership experience 8 or more years of technical experience Applicable State licensure in field of study Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Additional Information 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. $104,000 - $143,000 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. 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. --- Questions: -

Please answer the questions below.

- Have you ever worked for Humana Inc. and/or its affiliates and subsidiaries (collectively “Humana”) before as an Associate, Intern, or Contractor/Temporary Worker? - Yes - No - Our Department of Defense contract requires U.S Citizenship for this role. Do you meet this requirement? - Yes - No - If offered a position with Humana Government Business you may be required to go through the NBIS process to obtain Government Security Clearance to work on government systems. This requires the completion of a 100+ page document on-line, finger printing, background check, credit check and, completion of an employment application and drug test. The financial/credit check portion requires an in depth review of any failure to meet financial obligations within the past 7 years, including but not limited to bankruptcy, debt over 120 days delinquent and/or $15,000 threshold for bad debt (items in collection and charge off). Are you willing to go through this process? - No - Yes - Do you have dual citizenship with any other country? - Yes - No - If offered the job you may need to provide a copy of a Birth Certificate (government issued – not hospital copy), Birth Certificate for Birth Abroad, Naturalization Certificate, Citizenship Certificate or Valid Passport (must not be expired). This is required to initiate the NBIS process. Do you have one of these documents available? - No - Yes - Will you now or in the future require immigration sponsorship by our company to attain or maintain your employment eligibility (e.g., H-1B, E-3, TN, 0-1, STEM OPT, or any immigration work authorization requiring a written submission from the company to a government agency)? - Yes - No - Do you reside in the location for this job posting or within commutable distance? - Yes - No - What are your salary expectations for this job? - Please explain your reason for leaving your current or last position. - Have you ever been employed by the Federal Government, a contractor (including subsidiaries, parents, and affiliates) that performed work for the Defense Health Agency – DHA, served in the Military, and/or were a Political Appointee? - In the past five years, have you been employed by a state or local government entity, either as an employee, special government employee, contractor, consultant, or advisor? - No - Yes