[Hiring] AVP, Utilization and Care Management Strategy @Humana

Role Description

The AVP, Utilization and Care Management Strategy provides enterprise strategic leadership for Medicaid utilization management, care management, clinical policy governance, affordability initiatives, medical expense strategy, and performance oversight. Reporting to the VP, Medicaid Clinical Strategy and Affordability, this role leads the development and execution of a coordinated strategy designed to improve total cost of care, appropriate member access, care coordination, provider experience, quality outcomes, regulatory alignment, and program stewardship.

This is a strategy, governance, and cross-functional leadership role. The AVP is not expected to directly manage day-to-day utilization management or care management operations but will partner closely with operational leaders to shape priorities, establish strategic direction, define performance expectations, evaluate outcomes, and support scalable execution across Medicaid markets.

This leader is accountable for integrating utilization and care management strategy into a cohesive enterprise approach that supports the right care, at the right time, in the right setting, for Medicaid members. The role connects insights from various data sources to inform enterprise strategy and market-level action.

The AVP serves as a strategic liaison to Medicaid market leadership and partners across multiple departments to align enterprise strategies with market realities and ensure disciplined governance across a significant clinical and financial performance domain.

Responsibilities

• Lead enterprise Medicaid utilization and care management strategy.
• Establish strategic direction, governance routines, performance expectations, and enterprise priorities.
• Oversee Medicaid care management strategy at the enterprise level.
• Integrate utilization management and care management strategies.
• Use data to identify strategic opportunities and evaluate program performance.
• Oversee Medicaid clinical policy governance and medical necessity criteria.
• Partner with various departments to modernize utilization and care management approaches.
• Identify and prioritize major medical cost and utilization drivers.
• Advance strategic approaches that connect utilization insights to care management interventions.
• Partner with Finance and market leadership to establish performance management processes.
• Serve as a strategic partner to Payment Policy and related teams.
• Evaluate and shape strategy for selecting vendors and external partners.
• Provide strategic direction for programs that improve care transitions.
• Ensure strategies support Medicaid regulatory expectations and health equity.

Qualifications

• 10+ years of leadership experience in relevant fields.
• Licensed clinical background (MD, DO, RN, NP, PA, PharmD, LCSW, or other relevant credentials).
• Experience developing strategy, governance models, and performance frameworks.
• Strong understanding of Medicaid managed care and regulatory requirements.
• Experience leading enterprise-wide initiatives that influence total cost of care.
• Proven ability to lead through influence in a complex matrixed environment.
• Strong analytical capability with experience interpreting various healthcare data.
• Ability to translate strategic priorities into executable roadmaps.
• Strong executive communication and stakeholder management skills.
• Bachelor’s degree in a relevant field or equivalent experience.

Requirements

• Physician leadership experience in managed care or Medicaid (preferred).
• Advanced degree in a relevant field (preferred).
• Multi-state Medicaid managed care experience (preferred).
• Experience with enterprise strategy and performance management (preferred).
• Experience with vendor strategy and payment integrity (preferred).

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including personal holidays and parental leave.
• Short-term and long-term disability.
• Life insurance.
• Other opportunities for personal wellness and healthcare decisions.

Additional Information

This role provides focused executive leadership for the Utilization and Care Management Strategy pillar within the Medicaid Clinical portfolio. The AVP will be accountable for strategy development, execution oversight, governance, market alignment, and cross-functional integration across various objectives.

Work at Home Requirements: Minimum internet speed of 25 Mbps download and 10 Mbps upload is required.

Travel: Occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours: 40

Pay Range: $203,400 - $279,800 per year, eligible for a bonus incentive plan.