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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive clinical leadership and strategic oversight in Medicaid and managed care environments, with a focus on quality improvement, utilization management, and population health. Proven ability to collaborate with diverse stakeholders and drive innovative clinical solutions while ensuring compliance and operational effectiveness.
Highest-signal resume keywords
M.D. Or D.O. DegreeCurrent Medical LicenseBoard Certification10+ Years Clinical Leadership ExperienceExperience In Managed Care
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ManagementCare ManagementQuality ImprovementPopulation Health ManagementMedical Cost ManagementStrategic LeadershipFinancial ManagementRegulatory ComplianceHEDIS/STARS PerformanceClinical Strategy Development
Soft Skills
Influencing Executive LeadersStakeholder EngagementCollaborationStrategic ThinkingCommunication
Certifications & Qualifications
Current Medical LicenseBoard Certification
Industry Keywords
MedicaidMedicareValue-Based CareIntegrated CareMLTSSD-SNPFIDE-SNPHealth Services OperationsQuality Management CommitteeAccreditation Organizations
About the role
Key responsibilities & impact- Provide market-based medical leadership and clinical strategy for Humana Healthy Horizons in Indiana
- Oversee clinical operations, quality, utilization management, population health, and medical cost strategy
- Serve as senior clinical representative to the State, providers, community partners, and other stakeholders
- Provide strategic and operational clinical leadership for Indiana Medicaid lines of business, including Medicaid-only, Medicaid LTSS, integrated Medicare-Medicaid products, and integrated D-SNP
- Support Medicaid business development, procurement strategy, stakeholder engagement, competitive market positioning, provider partnership opportunities, and innovative clinical solutions
- Provide medical leadership and strategy for Health Services Operations with fiscal responsibility for trend management
- Collaborate across internal and external stakeholders in a highly matrixed environment
- Oversee utilization management, care management, quality operations, and medical necessity strategies
- Lead clinical strategy, performance, compliance, and operational effectiveness of care management programs
- Lead market-level clinical programs and quality improvement initiatives, including HEDIS/STARS performance, peer review activities, and Quality Management Committee governance
- Partner with providers, facilities, and ancillary networks to strengthen relationships, support contracting activities, and drive value-based and risk-sharing arrangements
Requirements
What you’ll need- M.D. or D.O. degree
- Current, unrestricted medical license and board certification
- Ability to practice in Indiana
- 10+ years of progressive clinical and healthcare leadership experience
- Experience in managed care, Medicaid, Medicare, or value-based care environments
- Proven experience leading utilization management, care management, quality improvement, population health, and medical cost management strategies
- Ability to influence executive leaders, state partners, and cross-functional teams
- Experience partnering with providers, health systems, community organizations, and government stakeholders
- Strong strategic, financial, and executive leadership skills
- Experience working directly with state Medicaid agencies, CMS, accreditation organizations, and regulatory oversight entities
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Preferred: senior clinical leadership experience in Medicaid managed care, integrated care, MLTSS, D-SNP, FIDE-SNP, or other Medicare-Medicaid integrated models
- Preferred: medical management experience with health insurance organizations, hospitals, healthcare providers, and patient interaction
- Preferred: Internal Medicine, Family Practice, Geriatrics, Hospitalist, ER, PM&R clinical specialization
- Preferred: Master's Degree
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- Medical, dental, and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Dedicated work-from-home space
- Remote work arrangement
- Occasional travel to Humana offices for training or meetings