Director of Utilization Management (UM) Cost of Care Strategy

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 The Director of Utilization Management (UM) Cost of Care Strategy provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Director of Utilization Management (UM) Cost of Care Strategy requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Director of Utilization Management (UM) Cost of Care Strategy plays an important role within utilization management at Humana to define, prioritize and execute on our key strategic priorities to drive appropriate care in order to improve cost of care and clinical outcomes; identify efficiencies; and improve experiences across members, associates and providers. You are driven by the opportunity to use your strong strategic and analytical acumen to drive impact and create significant measurable value. You are passionate about collaboration and partnering across the enterprise (e.g., Clinical Operations, Markets, Care Management, Clinical Strategy, Analytics, Pharmacy, Advocacy, etc.) to develop pragmatic, high value strategies and drive exceptional operational execution of our key objectives. You are curious – you enjoy connecting the dots between business metrics and frontline, understanding key root causes for what we see in data, testing hypotheses for what we could improve to drive value, and transforming ideas into action.

You will provide pivotal leadership integral to Humana achieving its vision to reimagine utilization management and drive transformative change in the coming 3-5 years, resulting in positive impact for providers, members, industry & legislative stakeholders, as well as Humana.    

Responsibilities

Strategy and scoping:

• Conduct multi-pronged discovery on utilization management at Humana – past approaches & learnings at Humana, current initiatives & challenges, current & future industry dynamics, competitive landscape, etc.  
• Develop learning agendas and partner with analytical functions to rigorously study UM trends and outcomes, and leverage data and insight to continuously improve program outcomes
• Assess where to play (e.g., highest value opportunity spaces) and how to win (e.g., tactics and capability requirements for opportunity capture) – develop strategic framework, conduct relevant quantitative analyses and feasibility assessments to prioritize highest value strategic initiatives
• Collaborate with key partners across enterprise to co-develop strategies / priorities – working hand-in-hand with Clinical Operations and Market partners, ensuring connectivity into broader enterprise strategies and with broader clinical assets (such as Care Management and Pharmacy), informing strategies with data-driven insights from …