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The Market Entry Capture Strategy Lead will lead initiatives to develop and execute strategy to successfully position Humana to capture growth opportunities. This role will work horizontally across the organization, coordinating with Medicaid leadership and operational subject matter experts to synthesize, assess, and translate state requirements into actionable go-to-market strategy. The Lead will consult with growth partners to design and optimize operating model blueprints for viable Medicaid health plans that meet the needs of state clients and populations served in target growth markets.
Humana Medicaid is seeking exceptional candidates to join our Medicaid Product Strategy Organization to advance Humana's Medicaid products and capabilities and support the strategic direction and growth of the Medicaid and Duals lines of business. This is a unique opportunity for a motivated individual to influence the mission of a leading healthcare company committed to improving the health of the communities it serves.
The Medicaid Capture Management team's purpose is to successfully position Humana to enter new markets enabling the future of the business. As a centrally positioned strategic function this team coordinates with growth partners across the enterprise to accelerate product strategy and define the operating model for new markets. We deliver value through detailed research, data-driven insights, strategic planning, structured problem solving, and project management rigor.
We are a diverse set of highly skilled people with deep Medicaid subject matter expertise who work in an agile, collaborative environment. To achieve our goals, we empower associates to pioneer simplicity, rethink routine and seek talent with the following attributes
Creative - Adept at research to determine the opportunity and a structured yet flexible approach to problem solving
Adaptive - Rapidly learn new knowledge, skills, and behaviors in response to changing circumstances
Self-sufficient - Ability to navigate complex situations and independently produce high quality deliverables
Consultative - Build/sustain relationships and inform the work of others through actionable, objective insights
Strategic - Forward thinking capable of providing frameworks?to maximize ability of limited resources to achieve growth
The Capture Lead, Medicaid Plan Configuration and Member Strategy will lead initiatives to develop and execute strategy, specifically focused on value delivery to members though differentiated benefits and experience, to successfully position Humana to capture growth opportunities. This role will work horizontally across the organization, coordinating with Medicaid leadership and subject matter experts across various functions to synthesize, assess, and translate state requirements into actionable go-to-market strategy. The Lead will consult with both growth and operational partners to design and optimize operating model blueprints for viable Medicaid health plans that meet the needs of state clients and populations served in target growth markets.
Candidates will possess Medicaid managed care operations expertise and have experience in designing solutions for key Medicaid programs and subpopulations. Ideal candidates will possess a broad range of knowledge spanning across member, products and benefits, and health plan administration portfolios (provider, claims, etc.), with areas of focus including Enrollment, Member Experience, Value-Added Benefits, Wellness and Subcontractor Management.
Key responsibilities include:
Research and assess prospective new markets. Gather key information on market and regulatory landscape and translate state policy to discern impacts to Humana's operating model as it pertains to member value.
Coordinate operational teams to translate contract requirements, market intelligence, and industry best practices intoa viabletarget operating model for products & benefits and member experience.
Lead cross-functional teams of growth partners and health plan leaders to develop high-impact, innovative, and competitive market entry strategyfor upcoming growth opportunities.
Develop project plans and roadmaps, drivingtimely completion of deliverables by cross-functional project team.
Track project status and report on progress to leadership.
Participate in the proposal development process. Provide content and recommendations to help shape responses to state procurements and clearly articulate Humana'soperational strategy.
Document and clearly communicate operating model features to relevant teams to support proposal development and transition to implementation.
Use your skills to make an impact
Required Qualifications
Bachelor's Degree with a strong record of academic achievement
5+ years' experience in a Medicaid or Medicare Managed Care Organization
5+ years' experience in Medicaid business development and strategy consulting
Experience and understanding of the Medicaid ecosystem, managed care health services operations, business development lifecycle, and strategic planning
Experience leading cross-functional teams to design a strategy and/or product
Strong problem-solving ability (i.e. adept at research and generating creative solutions)
Ability to operate in a fast-paced environment under tight deadlines and in ambiguous situations
Highly organized and analytical with a strong attention to detail
Advanced Proficiency in Microsoft Office Products (i.e. Word, Excel, PowerPoint, Visio)
Adept at quantitative and qualitative research
Excellent verbal and written communication and presentation skills
Preferred Qualifications
Master's?Degree in Public Health, Health Policy or Health Administration programs
MBA programs with a specialization in Healthcare Management
Project Management and Process Improvement qualifications
Additional Information
Travel: Role will include travel (10% of time)
Workstyle: Hybrid Office if you live within commuting distance of our office locations in Tampa, FL or Louisville, KY; Remote if you live outside of Tampa, FL and Louisville, KY
Core Work Days & Hours: Monday - Friday; Eastern Standard Time (EST) with flexible scheduling (i.e. occasional nights and weekends)
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
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
40Pay 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 06-22-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - 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 - 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.
?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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.