Humana Director, Clinical Trend in Colorado Springs, Colorado
Humana's Enterprise Clinical Management (ECM) organization is seeking a Director, Clinical Trend. As a clinical trend leader you will work with various partners in retail 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, with a specific focus on chronic conditions and Medicare population including Enterprise Clinical Operating Model (ECOM). 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.
Responsible for developing a pipeline of clinical initiatives that could positively impact trend including member experience, health outcomes and costs:
Understand the member/patient experience and clinical data insights to identify options for decreasing friction points for members and providers
Combine knowledge of the member experience with analytics and data insights to identify areas of opportunity to reduce trend and improve health outcomes
Guide data analysts and lead the generation of insights by asking good clinical questions of the data
Make recommendations about actions or initiatives to address/impact high cost conditions/areas of opportunity
Identify emerging health concerns/needs for our members and levers that can make a difference for our members' health and costs
Complete literature searches to identify trend opportunities related to patient health outcomes, to investigate root cause analyses of trend opportunities and identify interventions and best practices to directly impact trend and patient health outcomes
Monitor relevant clinical research and publicly available news and reports in the healthcare industry, performing any ad hoc analyses and horizon scanning as needed
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 leaders and associates in Retail business, Clinical Strategy, Digital Health and Analytics and the Clinical Product Organization to develop data-driven, technology-enabled enterprise-wide solutions to improve health outcomes, member experience at lower cost.
Master's degree + in a quantitative (health services research, public health, epidemiology, HEOR, biostatistics) and/or clinical field with at least 10 years of related work experience in clinical, trend and/or analytics
Experience working with 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
Clinical degree preferred (MD, PharmD, BSN, APRN, etc.)
Prior data analytics and research experience
Exposure to data exploration tools like python, SAS, PowerBI etc.
Experience in the managed care industry
This is a remote opportunity nationwide (U.S.)
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
Scheduled Weekly Hours