Senior Clinical Insights Professional

Profile

Description

Responsibilities

The Senior Clinical Insights Professional delivers clinical policy insight and information to both internal and external customers for Humana Government Business (HGB). The Senior Clinical Insights Professional will draft and review TRICARE clinical policy in order to complement utilization, cost and quality strategies. Meets regularly with the Chief Medical Officer and medical directors for HGB to include leading and hosting meetings. Works with markets, physicians, and other provider organizations to address clinical issues and strategies. Serves as key internal HGB clinical policy resource for multiple departments, especially utilization management and care management groups. Leverages clinical experience and deep knowledge of managed care to find the best solutions for all customers. Influences HBG's health services strategy by making decisions on complex issues regarding technical approach for policy components. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

Bachelor's degree in Nursing, Healthcare Management or related field

Active R.N. (Registered Nurse) license in the state of employment

3 or more years of experience in researching evidence-based care (Medical journals, published formal technology assessments, national medical association literature, clinical trials etc... ) to formulate coverage recommendations

Demonstrated ability to define and track KPIs and other measurable success criteria

Prior experience working in a managed care organization to include Medicare, Medicaid, TRICARE and/or Commercial products

Deep understanding of strategic planning, and research processes

Strategic thinking and planning capabilities; organized and detail-oriented

Excellent written and verbal communication skills

Proficiency with all Microsoft Office products to include Word, PowerPoint and Excel

Our Department of Defense contract requires U.S. citizenship

Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

NCQA or URAC accreditation experience

Demonstrative level of knowledge of the state and federal legislative and regulatory process

Familiar with content management systems

Conversant and comfortable with principles of design, writing and editing

Extensive knowledge of TRICARE policies and programs

Experience with TRICARE contracts and/or the military health care delivery system

Graduate degree in Business, Health Care, Health Care Administration, or other related field

Additional Information

Work Location : Louisville, KY (Forum III building) Or Remote

Work Style : Traditional office setting ( Post Covid-19 ) or Remote ( If you are located 2 hours outside of Louisville, KY )

If you are located in the Louisville, KY market. You will be temporarily working at home due to COVID-19 . In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, this position may be subject to temporary work at home requirements for an indefinite period of time. The remote requirements include a minimum internet connection speed of 10m x 1m, and a dedicated secure home work-space. Humana continues to monitor the situation, and will adjust service levels as the COVID-19 situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations.

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire Text to enhance our hiring and decision-making ability. Modern Hire Text 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.

If you are selected for a first round interview, you will receive a correspondence inviting you to participate in a Modern Hire Text interview. In this interview, you review a set of interview questions over your phone or computer and you will provide text responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your text message interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com