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Humana Clinical Trend Lead in Boston, Massachusetts

Description

The Strategy Advancement Advisor 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 Strategy Advancement Advisor works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

Location: work at home anywhere

Humana's ECM organization is seeking a Clinical Trend Lead. As a Clinical Trend Leader you will work with various partners in commercial business, enterprise clinical strategy, clinical products and various analytical organizations to lead data analyses and generate actionable clinical trend insights. This individual will employ a strategic data-driven approach, coupled with clinical and business acumen, to guide Humana trend monitoring and forecasting processes, with a specific focus on commercial/employer group book of business. Through a rigorous focus on both financial and clinical outcomes, this individual will ultimately enable the insights and actions to bend Humana's clinical trend.

Responsibilities include:

  • Contribute to a pipeline of clinical initiatives that could positively impact trend, member experience, health outcomes and costs

  • Lead and support clinical cohort, disease state and other types of clinical investigations to inform care management and utilization management strategies.

  • Make recommendations for the actions or initiatives needed to address high cost conditions and identified trend opportunities

  • Support clinical strategy value assessment, forecasting the savings of a strategy through rigorous clinical assumptions and financial metrics and tracking actual experience to projection

  • Complete literature searches to identify areas of trend investigation and guide metric development

  • Monitor relevant publicly available news and reports in the healthcare industry, performing any ad hoc analyses and horizon scanning as needed

  • Facilitate meetings associated with investigations, document follow ups and share notes as needed.

  • Produce high quality presentations and reports to be shared with senior leadership such as trend updates

Role Essentials

  • Masters or Doctoral degree in a quantitative and/or clinical field (eg: clinical informatics, public health, epidemiology, HEOR, biostatistics, pharmacy, nursing, medicine)

  • 6 years or more of experience working with and interpreting healthcare data

  • Strong business and financial acumen

  • Ability to assimilate, analyze and generate insights from complex data

  • Excellent meeting facilitation skills

  • Strong MS PowerPoint and Excel skills

  • Strong literature search and evaluation skills, including familiarity with PubMed and other search engines

Role Desirables

  • Clinical degree (PharmD, MD, BSN, APRN, PA, etc.) combined with quantitative degree is preferred

  • Clinician informaticist or similar will be considered

  • Administrative healthcare data subject matter expertise

  • Prior healthcare research or analytics consulting experience

  • Familiarity with various clinical terminologies e.g. ICD10, DRG, CPT, J codes etc.

  • Exposure to data exploration tools like python, SAS, PowerBI etc

  • Commercial payor experience

Additional Information

Humana is an organization with careers that change lives-including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Travel

Less than 10%

Scheduled Weekly Hours

40

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