Humana Clinical Trend Medical Director in Louisville, Kentucky
Humana's Enterprise Clinical Management team needs your clinical, business and analytics acumen to solve for the healthcare challenges of today. The Clinical Analytics and Trend team uses advanced scientific techniques, data analysis, forecasting, and clinical acumen to identify clinical opportunities to improve health outcomes and improve the value of care for our members. In this exciting start-up environment, you'll have the opportunity to develop trend investigation processes from the ground up, while working collaboratively with clinicians, actuaries and business owners across Humana.
Title : Clinical Trend Medical Director
Assignment: Enterprise Clinical Management, Clinical Analytics and Trend
Location: Louisville, KY or Work At Home
Humana's ECM organization is seeking a Clinical Trend Medical Director. As a clinical trend leader you will work with various partners in the business, enterprise clinical strategy, clinical products and various analytical organizations to lead data analyses and generate actionable clinical trend insights. This leader will employ a strategic data-driven approach, coupled with clinical and business acumen, to guide Humana trend monitoring and forecasting processes. Through a rigorous focus on both financial and clinical outcomes, this leader will ultimately enable the insights and actions to bend Humana's clinical trend.
Develop a pipeline of clinical initiatives that will positively impact Humana's medical trend, member experience, health outcomes and costs
Lead Humana's analytics strategy to identify and address low value care and related healthcare resource waste, with a focus on optimizing Humana's utilization management processes
Guide data analysts and lead the generation of insights by asking good clinical questions of the data
Combine knowledge of clinical management with analytics and data insights to identify areas of opportunity to reduce trend and improve health outcomes
Make recommendations about actions or initiatives to address high cost conditions and ECOM cohorts
Identify emerging health concerns/needs for our members and levers that can make a difference such as clinical products, utilization management, networks and contracting
Collaborate closely with associates in Data Health and Analytics, Clinical Strategy, Commercial Business and the Clinical Product Organization to develop data-driven clinical solutions
Lead the clinical strategy value assessment, forecasting the savings of a strategy through rigorous clinical assumptions and financial metrics and tracking actual experience to projection
Demonstrate high accountability to assumptions and trend benders
Complete literature searches to identify areas of trend investigation and opportunity
Monitor relevant publicly available news and reports in the healthcare industry, performing any ad hoc analyses and horizon scanning as needed
Produce high quality presentations and reports to be shared with senior leadership such as trend updates
Advanced clinical degree (MD, DO, PharmD, APRN, PA) with experience working in an administrative, analytics, finance, managed care role or similar to develop strong business acumen
Quantitative formal education (health services research, public health, epidemiology, HEOR, biostatics) or equivalent experience
Deep experience and subject matter expertise with administrative healthcare data
Familiarity with various clinical terminologies e.g. ICD10, SNOMED, RxNorm etc.
Experience leading teams, either through influence or direct authority, to execute on complex projects
Demonstrated ability to lead through ambiguity and function independently
Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
Experience with and knowledge of utilization management processes, preferably within a commercial payer setting - former/current medical directors will be considered
Prior data analytics and research experience
Exposure to data exploration tools like python, SAS, PowerBI etc
Healthcare is rapidly changing, and our members are living longer, often with more chronic conditions. Consumers expect more personalized and holistic experiences from their health partners. Humana's Enterprise Clinical Operating Model (ECOM), is a multi-year strategy with the goal of improving member experiences and health outcomes through better integrating Humana's processes, technology and clinical capabilities. The person occupying this role will be instrumental in executing on the vision of ECOM in partnership with leaders and teams across Humana.
Less than 10%
Scheduled Weekly Hours