Humana · 1 day ago
Clinical Business Lead
United States
Full-time
Remote
Mid, Senior Level
$104K/yr - $143K/yr
5+ years expHumana Inc. is committed to putting health first, and they are seeking a Clinical Business Lead to lead teams responsible for care management. The role involves analyzing performance data, collaborating with stakeholders, and ensuring compliance with clinical standards to improve healthcare delivery.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Analyze chronic condition performance so regional clinical leadership can bring insights to provider groups to drive awareness, education and action plans
Evaluate the effectiveness of clinical program initiatives through analysis of the downstream impact of such initiatives on facility and provider performance in value-based programs
Identify opportunities for new clinical program initiatives by assessing cost and utilization drivers, inclusive of a chronic condition focus
Support facility case review discussions with pre-meeting analysis of submitted case reviews as needed
Prepare data and evaluate performance to support RVP and HSD in governance and delegation oversight committee and interact with the corporate delegation compliance and auditing teams
Collaborate with cross-functional teams and internal stakeholders to ensure alignment of clinical strategies with regional executive leadership
Serve as a clinical liaison to the provider engagement team to ensure consistent execution of initiatives
Collaborate with the delegation team to identify and resolve performance issues or access concerns
Support regional leadership in maintaining compliance with clinical best practices and regulatory standards
Participate in continuous quality improvement initiatives, including root cause analysis, best practices to close care gaps
Coordinate the implementation of clinical vendor programs across the region, ensuring operational readiness, provider education, and ongoing support for seamless integration
Assist in the evaluation of clinical program pilots and vendor supported initiatives through analysis and monitoring of key performance indicators
Track vendor performance metrics and collaborate with finance team to prepare performance reports to support data-driven decision making and support a ROI
Review the delegation team audits and, if needed, supplement them with regular reviews to ensure vendor programs comply with regulatory standards and internal policies
Provide insights to inform program scalability and effectiveness
Qualification
Required
Bachelor's degree in a health-related field (e.g., Nursing, Public Health, Epidemiology, Healthcare Administration)
Minimum of 5 years of clinical experience
Minimum 3 years of experience in data analytics, clinical operations, care management, quality improvement, or vendor oversight
Proficient in analyzing and presenting data using visualization tools (e.g., Excel, Tableau, Power BI) and interpreting it for various audiences
Strong understanding of value-based care, population health, and clinical quality metrics
Experience managing or supporting third-party vendor relationships in a healthcare setting
Excellent organizational, communication, and problem-solving skills
Proven ability to provide high-quality, responsive service to internal and external stakeholders
Demonstrated ability to lead through influence and collaborate across teams
Thrive in a remote work environment with independent work skills
Travel expected 5-15%
Preferred
Advanced Degree (such as MSN, MBA, MHA, MPH)
Experience in managed care, health plan operations, or Medicare Advantage programs (including various SNP products) or Managed Medicaid
Familiarity with remote monitoring, digital health tools, or clinical innovation platforms
Project management experience or certification (e.g., PMP, Lean Six Sigma)
Benefits
Medical, dental and vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Cynthia Zipperle
Vice President, Chief Accounting Officer and Controller
Recent News
2026-02-04
HealthCareIT News
2026-02-04
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2026-02-04
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