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The Program Delivery Lead will lead the strategy, implementation, and operational execution of Medicaid Revenue Optimization and Member Activation programs. This leader will partner across Finance, Market Operations, Risk Adjustment, Care Management, Encounters, Compliance, Market Leadership, Product, and external vendors to ensure members receive benefits for which they qualify while maximizing appropriate reimbursement and revenue opportunities.
The role is accountable for program performance, market expansion, vendor governance, stakeholder alignment, and the delivery of measurable financial and operational outcomes. The successful candidate will be an expert at navigating complex Medicaid environments, influencing across matrixed organizations, and translating strategic opportunities into scalable operational solutions.
The Program Delivery Lead will lead the strategy, implementation, and operational execution of Medicaid Revenue Optimization and Member Activation programs. This leader will partner across Finance, Market Operations, Risk Adjustment, Care Management, Encounters, Compliance, Market Leadership, Product, and external vendors to ensure members receive benefits for which they qualify while maximizing appropriate reimbursement, revenue, and cost-of-care opportunities.
The role is accountable for program performance, market expansion, vendor governance, stakeholder alignment, and the delivery of measurable financial and operational outcomes. The successful candidate will be an expert at navigating complex Medicaid environments, influencing across matrixed organizations, and translating strategic opportunities into scalable operational solutions.
Key Responsibilities
Revenue Optimization Program Leadership
- Lead Medicaid revenue optimization initiatives including but not limited to:
- SSI eligibility identification and conversions
- ESRD Medicare and non-dual to dual transitions
- Member activation and engagement initiatives
- Condition based solutions
- Develop and execute multi-year program roadmaps aligned with organizational growth objectives.
- Identify opportunities to improve program performance, financial outcomes, and member engagement and experience.
- Monitor leading and lagging indicators to proactively manage business performance.
Operational Execution
- Oversee end-to-end program delivery from strategy through implementation and ongoing operations.
- Establish operational frameworks, governance structures, KPI reporting, and performance management processes.
- Remove barriers impacting outreach effectiveness, encounter acceptance, provider documentation, and vendor execution.
- Ensure program scalability across multiple Medicaid markets.
Cross-Functional Leadership
- Build strong partnerships across:
- Finance
- Clinical and Care Management
- Compliance
- Procurement
- Member and Provider Engagement
- Encounters Operations
- Medicaid Market Leadership
- Actuarial
- Facilitate executive-level discussions regarding performance, opportunities, and risk mitigation.
- Drive accountability across stakeholders to meet program objectives.
Vendor Management
- Lead strategic vendor relationships supporting member engagement and revenue optimization initiatives.
- Establish performance standards and monitor contractual outcomes.
- Evaluate vendor capacity, quality, operational efficiency, and financial value realization.
- Partner with vendors to develop innovative approaches to improve member activation and program completion rates.
Financial Performance Management
- Quantify business opportunities and expected financial outcomes.
- Develop business cases and ROI analyses for program enhancements and market expansions.
- Monitor revenue realization, cost structures, forecast performance, and financial risks.
- Present performance updates and recommendations to executive leadership.
Market Expansion & Innovation
- Support introduction of programs into new Medicaid markets.
- Navigate state-specific regulatory requirements and approval processes.
- Evaluate emerging revenue optimization opportunities and new member engagement strategies.
- Drive continuous improvement and innovation initiatives.
Preferred Competencies
Strategic Leadership
- Creates long-term strategies while maintaining operational rigor.
- Balances member experience, regulatory requirements, and financial performance.
Program Management Excellence
- Expert knowledge of large-scale program delivery methodologies.
- Demonstrated success managing complex, cross-functional initiatives.
Financial Acumen
- Strong understanding of:
- Medicaid financing
- Revenue optimization
- Business case development
- Forecasting and ROI analysis
Influencing & Executive Presence
- Ability to influence without direct authority.
- Comfortable leading discussions with senior executives and market leadership.
Data-Driven Decision Making
- Uses analytics to identify opportunities and drive outcomes.
- Builds actionable insights from operational and financial performance data.
Vendor & Partner Management
- Proven ability to hold vendors accountable while maintaining productive partnerships.
Change Leadership
- Successfully leads organizational change and adoption across matrixed teams.
Use your skills to make an impact
Required Qualifications
- Bachelor's degree
- 5+ years within Medicaid, Medicare, managed care, revenue optimization, risk adjustment, care management, or health plan operations.
- 5 or more years of technical experience
- 2 or more years of project leadership experience
- Strong knowledge of Microsoft Office XP products (Word, Excel, Access)
- Excellent communication skills, both oral and written
- Strong relationship building skills
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Experience leading enterprise-scale, cross-functional initiatives.
- Experience with vendor management and performance governance.
- Strong financial and analytical capabilities.
Preferred Qualifications
- Master's Degree in Business Administration or a related field
- PMP certification a plus
- Six Sigma Certification also a plus
- Knowledge and experience in health care environment/managed care
- Strong analytical skills
- Finance acumen
- Technical skill such as Power BI, Databricks, SQL
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: 08-30-2026
