Clinical Operations Lead

Join Our Caring Community and Make Health a Priority! The Clinical Operations Lead is at the forefront of leading teams composed of nurses and behavioral health professionals dedicated to care management. This role involves tackling a range of complex challenges that require innovative solutions. Key Responsibilities: Data-Driven Insights for Clinical Strategy and Performance: Analyze performance data on chronic conditions to assist regional clinical leadership in developing actionable insights for provider groups. Evaluate the success of clinical programs by assessing their impact on facility performance in value-based initiatives. Identify new opportunities for clinical program development, focusing on cost and utilization factors. Provide analytical support for case review discussions to prepare teams for effective meetings. Compile data to facilitate governance and compliance discussions with regional and corporate teams. Collaboration Across Teams: Work in partnership with internal teams to ensure the alignment of clinical strategies with executive leadership. Act as a clinical liaison to the provider engagement team, ensuring unified implementation of initiatives. Collaborate with the delegation team to promptly address performance or access concerns. Commitment to Compliance and Quality Improvement: Assist regional leadership in achieving compliance with clinical best practices and regulatory standards. Engage in continuous quality improvement efforts, focusing on root cause analysis and closing care gaps. Vendor and Pilot Program Management: Lead the implementation of clinical vendor programs, ensuring operational readiness and continuous support. Evaluate pilot clinical programs and vendor initiatives through comprehensive analysis of key performance indicators. Monitor vendor performance alongside the finance team to guide data-driven decisions and support ROI assessments. Regularly review delegation team audits to ensure compliance among vendor programs with regulatory and internal standards. Provide insights to enhance program impact and scalability. Use Your Expertise to Drive Change! Qualifications: Bachelor's degree in a health-related field (e.g., Nursing, Public Health, Healthcare Administration). Minimum of 5 years clinical experience. At least 3 years in data analytics, clinical operations, or vendor management. Proficiency in data analysis and visualization tools (e.g., Excel, Tableau, Power BI). Strong knowledge of value-based care and clinical quality metrics. Experience managing vendor relationships in healthcare settings. Excellent organizational and communication skills. Ability to provide exceptional service to stakeholders. Proven capacity to lead through influence and work collaboratively. Comfortable working in a remote environment, with independent work capabilities. Travel expected 5-15%. Preferred Qualifications: Advanced degree (e.g., MSN, MBA, MHA). Experience in managed care or health plan operations. Familiarity with digital health tools or remote monitoring solutions. Project management certification (e.g., PMP, Lean Six Sigma). Work-from-Home Requirements: Reliable internet service with a minimum download speed of 25 Mbps. Dedicated workspace free from interruptions and compliant with HIPAA guidelines. This position is remote but follows PST or MST standard business hours. Compensation and Benefits: The compensation for this role ranges from $104,000 to $143,000 annually, based on experience and qualifications. This position is eligible for a bonus incentive plan. Humana offers a comprehensive benefits package including medical, dental, vision, and a 401(k) plan, along with generous paid time off and additional perks. Join Humana! At Humana Inc. (NYSE: HUM), we are committed to prioritizing health for our teammates and the communities we serve. Together, we can ensure improved health and well-being for individuals and families across the nation. Equal Opportunity Employer: Humana does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or any other protected status.

Created: 2026-03-12