Overview

Humana is seeking a Program Delivery Lead to lead the strategy, implementation, and operational execution of Medicaid Revenue Optimization and Member Activation programs. This leader will partner across Finance, Market Operations, Risk Adjustment, Care Management, Encounters, Compliance, Market Leadership, Product, and external vendors to ensure members receive benefits for which they qualify while maximizing appropriate reimbursement, revenue, and cost-of-care opportunities.

The role is accountable for program performance, market expansion, vendor governance, stakeholder alignment, and the delivery of measurable financial and operational outcomes. The successful candidate will be an expert at navigating complex Medicaid environments, influencing across matrixed organizations, and translating strategic opportunities into scalable operational solutions.

Key Responsibilities

Revenue Optimization Program Leadership

• •Lead Medicaid revenue optimization initiatives including SSI eligibility identification and conversions, ESRD Medicare and non-dual to dual transitions, member activation and engagement initiatives, and condition-based solutions
• •Develop and execute multi-year program roadmaps aligned with organizational growth objectives
• •Identify opportunities to improve program performance, financial outcomes, and member engagement and experience
• •Monitor leading and lagging indicators to proactively manage business performance

Operational Execution

• •Oversee end-to-end program delivery from strategy through implementation and ongoing operations
• •Establish operational frameworks, governance structures, KPI reporting, and performance management processes
• •Remove barriers impacting outreach effectiveness, encounter acceptance, provider documentation, and vendor execution
• •Ensure program scalability across multiple Medicaid markets

Cross-Functional Leadership

• •Build strong partnerships across Finance, Clinical and Care Management, Compliance, Procurement, Member and Provider Engagement, Encounters Operations, Medicaid Market Leadership, and Actuarial
• •Facilitate executive-level discussions regarding performance, opportunities, and risk mitigation
• •Drive accountability across stakeholders to meet program objectives

Vendor Management

• •Lead strategic vendor relationships supporting member engagement and revenue optimization initiatives
• •Establish performance standards and monitor contractual outcomes
• •Evaluate vendor capacity, quality, operational efficiency, and financial value realization
• •Partner with vendors to develop innovative approaches to improve member activation and program completion rates

Financial Performance Management

• •Quantify business opportunities and expected financial outcomes
• •Develop business cases and ROI analyses for program enhancements and market expansions
• •Monitor revenue realization, cost structures, forecast performance, and financial risks
• •Present performance updates and recommendations to executive leadership

Market Expansion and Innovation

• •Support introduction of programs into new Medicaid markets
• •Navigate state-specific regulatory requirements and approval processes
• •Evaluate emerging revenue optimization opportunities and new member engagement strategies
• •Drive continuous improvement and innovation initiatives

Required Qualifications

• •Bachelor's degree
• •5+ years within Medicaid, Medicare, managed care, revenue optimization, risk adjustment, care management, or health plan operations
• •5+ years of technical experience
• •2+ years of project leadership experience
• •Strong knowledge of Microsoft Office products (Word, Excel, Access)
• •Excellent oral and written communication skills
• •Strong relationship building skills
• •Experience leading enterprise-scale, cross-functional initiatives
• •Experience with vendor management and performance governance
• •Strong financial and analytical capabilities

Preferred Qualifications

• •Master's degree in Business Administration or a related field
• •PMP certification
• •Six Sigma certification
• •Knowledge and experience in healthcare environment and managed care
• •Technical skills such as Power BI, Databricks, SQL

Compensation and Benefits

• •Pay range: $115,200 - $158,400 per year, plus bonus incentive eligibility
• •Benefits include medical, dental, and vision coverage, 401(k) retirement savings plan, paid time off, company and personal holidays, paid parental and caregiver leave, short-term and long-term disability, and life insurance
• •This is a remote position with occasional travel to Humana offices for training or meetings
• •Home internet requirements: minimum 25 Mbps download and 10 Mbps upload speed