Associate Vice President, Trend & Clinical Innovation ...

Become a part of our caring community and help us put health first The Associate VP, Strategy Advancement provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Associate VP, Strategy Advancement requires a in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide. The Associate VP, Trend & Clinical Innovation Strategy will play an important role within Clinical Operations at Humana to define, prioritize and execute on utilization management-focused initiatives to drive appropriate care to improve cost of care and clinical outcomes; identify efficiencies; and improve experiences across members, associates and providers. The AVP, Trend & Clinical Innovation Strategy will lead a multidisciplinary team that blends strategy, policy, clinical and vendor management and will report directly to Vice President, Clinical Ops Cost of Care Strategy. Specifically, this AVP, Trend & Clinical Innovation Strategy will be responsible for: + Identifying opportunity areas where we can address our members receiving inappropriate care via requirement of prior authorization, policy optimization and/or consistent policy enforcement + Identifying opportunities for reducing provider and member burden by removing prior authorization requirements at the provider, procedure and sub-procedure (e.g., diagnosis code, site of service, etc.) level + Identifying opportunities across the auth to claims process (e.g., slippage) + Identifying opportunities for integration of CM to improve member adherence to UM decisions/care pathways + Managing vended OP UM relationships (e.g., Cohere), including identification of trend and process improvements + Partners across enterprise to drive exploration and implementation of identified opportunities. Additional Responsibilities Include: + Partner with analytical functions to rigorously study operational analytics, trends and outcomes to identify opportunities in driving appropriate clinical decisions for members through utilization management/prior authorization process + Size impact of addressing opportunity including being responsible for assumptions and inputs used by analytic partners through pressure testing and validation using clinical literature, analysis from related initiatives, industry intelligence, feedback from markets/members/providers, etc. + Prioritize and manage portfolio of opportunities in order to achieve annual trend targets for Clinical Operations u2013 develop strategic framework, conduct relevant quantitative analyses and feasibility assessments to prioritize highest value strategic initiatives + Collaborate with key partners across enterprise to co-develop strategies / priorities u2013 working hand-in-hand with Clinical Operations and Market partners, ensuring connectivity into broader enterprise strategies and with broader clinical assets (such as Care Management, Pharmacy), informing strategies with data-driven insights from Analytics, Health Care Economics + Translate strategies into actionable solutions and plans for execution in collaboration with key partners / stakeholders (e.g., technology, operational teams, provider experience, etc.) + Provide team of approximately 15 associates with day-to-day leadership to drive progress and alignment for initiatives + Develop & execute process to ensure appropriate stakeholders have had opportunity to inform, decide or veto key decisions + Outline materials used to communicate and gain feedback on opportunity and solutions to key stakeholders and decisionmakers + Determine key metrics and progress milestones to track against + Proactively update and solicit senior leader alignment on key decisions through executive-level presentations and discussion facilitation Use your skills to make an impact Required Qualifications 10+ years of strategy advancement experience 10 years of healthcare consulting experience 8+ years of team management experience, leading large teams Utilization management knowledge Preferred Qualifications Health Plan experience Master's Degree 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. $184,800 - $254,100 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, u201cHumanau201d) 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 03-26-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first u2013 for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health u2013 delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. u200b Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our

Created: 2026-03-23