The Oncology Program Lead designs, implements, and optimizes clinical programs that drive quality, safety, and efficiency across healthcare delivery systems. The Clinical Strategy and Program Development Lead works on problems of diverse scope and complexity ranging from moderate to substantial. This role drives improvements in patient outcomes, quality, cost efficiency, and service delivery. Serving as the primary liaison between the organization and the Oncology UM vendor, the Program Lead brings deep expertise in clinical workflows, utilization management, and vendor operations. This role exercises independent judgment in managing complex clinical and operational issues, identifying risks, and implementing effective solutions with minimal supervision.
The Oncology Program Lead ensures adherence to evidence-based practices, regulatory standards, and organizational goals to improve patient outcomes and operational performance. Advises executives to develop functional strategies (often segment specific) on matters of significance.
Key Responsibilities:
Vendor Strategy & Performance Management
Lead end-to-end management of the oncology UM vendor, including performance oversight, governance, and strategic alignment
Establish contractual KPIs, SLAs, and quality metrics to ensure delivery of safe, effective, and efficient care
Analyze vendor performance data, identify trends, and drive continuous improvement initiatives
Conduct regular business reviews and performance discussions with vendor leadership
Drives timely closure of IOPs and CAPs
Clinical & Operational Oversight
Ensure adherence to evidence-based oncology guidelines, UM policies, and regulatory standards
Partner with internal clinical, operations, and compliance teams to optimize workflows and program outcomes
Evaluate vendor clinical processes and recommend enhancements to improve quality, consistency, and patient experience
Serve as a subject matter expert in oncology UM programs and clinical operations
Program Leadership & Execution
Lead complex initiatives and projects supporting oncology UM program optimization
Define program objectives, timelines, resource needs, and success metrics; manage execution end-to-end
Utilize data and analytics to inform decision-making and identify opportunities for efficiency and cost savings
Drive innovation and scalability within vendor-supported programs
Contract & Relationship Management
Support contract development, negotiation, and ongoing management of vendor agreements
Monitor compliance with contractual obligations and address gaps or risks proactively
Investigate and resolve invoice, performance, and contractual discrepancies
Build and maintain strong, collaborative relationships with vendor partners and internal stakeholders
Cross-Functional Collaboration & Influence
Collaborate across departments including Clinical, Network, Finance, Compliance, and Operations
Lead stakeholder forums, executive updates, and cross-functional meetings
Travel may be up to 25%
Use your skills to make an impact
Required Qualifications
Registered Nurse (RN)
7+ years of experience in vendor management, program management, or clinical operations
3-5 years or more of oncology experience in case management, utilization management
or quality review or auditing
Experience applying clinical guidelines and medical policies
Experience reviewing oncology treatment plans
Proven ability to manage complex programs and drive performance outcomes
Advanced analytical, problem-solving, and decision-making skills
Proficiency in Microsoft Office tools (Excel, Word, Outlook); ability to work with data systems and reporting tools
Role Desirables
Master’s degree in Nursing, Healthcare Administration, Public Health, or related field
Experience working with oncology UM vendors or specialty benefit management program
Additional Information
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [redacted] with instructions on how to add the information into your official application on Humana’s secure website.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$115,200 - $158,400 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 08-03-2026
