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Company

Humana · 5 hours ago

Medicaid Lead, Technology Solutions

Oklahoma, United States

Full-time

Remote

Senior Level, Lead/Staff

$115K/yr - $159K/yr

10+ years exp

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Health CareHealth Insurance

No H1B

U.S. Citizen Only

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Responsibilities

This State Technology Lead must reside full-time within the state of Oklahoma

This State Technology Lead role will exclusively cover the Oklahoma Medicaid product lines.

Builds and maintains relationships with regulators and business leaders to understand the business strategy and needs and to advocate technology solutions to deliver results

Participated in state Readiness Reviews, including arranging with other IT experts to present, as needed, for topics where additional expertise may be needed

Stays current on relevant technologies leading efforts to match business needs with best technology solutions

Organize and run any one-time or recurring technology-related meetings with state personnel, and/or with the state’s technology partner

Provide thought leadership for state regulators, Humana market leaders, and occasionally other MCOs when multi-MCO implementations are involved

Collaborate with Market Operations/leadership in problem solving and help with workarounds as required to meet state deadlines that are in significant conflict with Humana IT’s development timelines

Serves as the “Senior Business Architect” for Medicaid, with a strong understanding of how the industry’s standard processes are executed in Humana’s environment, from end to end

Help develop and maintain all state-level Humana IT P&Ps, working with Humana IT compliance, the Privacy Office, and other internal areas as needed

Be on point for the technology portion of all state Medicaid compliance audits. These will often tie back to P&Ps

Participate in Command Centers or other operationally focused meetings as determined by each market

Participate in Market President’s senior leadership meetings, as appropriate

Ensure documentation is gathered and distributed to the appropriate market and IT peers for any state led meetings

Accountable for partnering with IT Operations in monitoring contractual SLA performance for State contracts to successfully deliver and avoid potential millions in liquidated damages and maximize revenue

Responsible for state technology roadmap including delivery of strategic imperatives to position to win and re-win contracts at renewal

Accountable for collaborating with business and IT peers to collect, maintain and store specifications, documentation, design documents, process flows, etc. relating to the state implementation.

Work with teams to gathers business requirements and clarify scope during initial discovery by conducting meetings/interviews, and facilitating large group/cross-functional sessions with partners

Effectively influences key stakeholders, team members, and peers outside of direct control of this role, to deliver optimal solutions in line with the best interests and expectations of the business partner.

Conducts executive level briefings presentations and solution recommendations

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Healthcare OperationsMedicaid Managed CareContinuous ImprovementBusiness ArchitectureClaims ProcessingProvider Data ManagementClinical OperationsProcess ImprovementRFP ResponsesIT ComplianceDocumentation ManagementStakeholder InfluenceExecutive PresentationsStrategic Partnerships

Required

Solid understanding of operations, technology, communications, and processes

Solid understanding of healthcare operations, particularly around claims processing, enrollment, provider data management and clinical operations; Medicaid preferred

Comprehensive understanding of a Medicaid Managed Care architecture, tools, utilities and processes utilized to deliver on core competences

Possess 10+ years of progressive experience leading continuous improvement efforts, evaluating existing systems and implementing process improvements.

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

US Resident

While this is a remote opportunity, it will require the willingness to travel to the market office and state office as needed