Senior Strategy Advancement Professional - Medicaid Risk Adjustment MRA

Profile

Description

Humana Healthy Horizons - Medicaid Risk Adjustment (MRA) team is committed to advancing the related capabilities across the Medicaid line of business through the development and administration of national programs, cross functional coordination of Risk Adjustment activities, business development support, new market implementation, and ongoing wrap-around market support.

Humana Healthy Horizons - Medicaid Risk Adjustment (MRA) team is seeking a Senior Strategy Advancement Professional who will provide data-based strategic direction to identify and address business issues and opportunities. The Senior Strategy Advancement professional will provide business intelligence and strategic planning support for business segments or the company at large. The Senior Strategy Advancement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Strategy Advancement Professional for Medicaid Risk Adjustment leads initiatives to analyze complex business problems and issues using data from internal and external sources.

Implements and manages Louisiana (ACG Johns Hopkins) and Ohio (CDPS Rx) risk adjustment models.

Works with others on the MRA team and cross-functionally with national leadership & market leadership and colleagues to establish logic for internal risk score calculations for LA/OH members.

Responsible for data strategy regarding member engagement and provider outreach within our Louisiana and Ohio markets.

Brings expertise or identifies subject matter experts in support of multi-functional efforts to identify, interpret, and produce recommendations and plans based on company and external data analysis.

Ensures that policies and procedures align with corporate vision.

Begins to influence department's strategy.

Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.

Exercises considerable latitude in determining objectives and approaches to assignments.

Creates logic and builds processes associated with Medicaid risk adjustment.

Other responsibilities as determined by leader.

Required Qualifications

2 years of experience Medicare, Commercial and/or Medicaid risk adjustment models.

3 years of data mining and analysis.

2 years of experience with SQL

2 years of experience in PowerBI, Tableau, or other data visualization software.

Expertise working with large complex data sets and performing root cause analysis.

In depth experience in Microsoft Office including Excel formulas, pivots, charts, graphs, etc.

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire.

Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

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

Preferred Qualifications

2 years of experience with Johns Hopkins ACG and/or CDPS Risk Adjustment models.

Experience with forecasting and predictive modeling techniques.

Ability to use data to drive business outcomes and decisions.

Additional Inform ation

Travel: up to 5% outside the state of residence.

Typical Work Days & Hours: Monday - Friday;9am - 5pm Eastern Standard Time (EST).

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice 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