Become a part of our caring community and help us put health first
 

Humana is a $100 billion (Fortune 40) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health of the people served, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.
Humana is committed to putting health first—for its teammates, its customers, and its company. Through its insurance services and CenterWell healthcare services, Humana makes it easier for the millions of people served to achieve their best health, delivering the care and service they need, when they need it. The result is a better quality of life—not only for people with Medicare and Medicaid but also for families, military service personnel, and communities at large. 
Business Strategy
Humana’s strategy is centered on providing a consumer-focused, integrated care experience that makes it easy for people to achieve their best health through outstanding clinical capabilities and through an experience that is simple and personalized. A key component of this strategy is Humana’s Integrated Care Delivery model, which places customers at the center of everything it does, with a focus on helping them manage their health holistically.
Humana recognizes that health and lifestyle are intrinsically connected. By addressing social determinants of health and by removing difficult friction points for customers and their healthcare providers and caregivers, it can help people change unhealthy behaviors. Humana is a leader in adopting value-based payment models that reimburse for health outcomes, as opposed to services performed, which can improve health, boost quality, and control costs.
Finally, Humana is integrating systems and processes using the latest technology to create a simpler, better customer experience. The ultimate goal of this approach is to enable the best possible health and experience at an affordable cost.
Context:
Overall health is a function of both physical health and mental health. As a national leader in integrated care, Humana is committed to creating market leading provider and member experiences enabling improved health outcomes.
The facts:
• Over 35% of HUM’s Medicare and Medicaid members have a BH diagnosis, including mild to moderate BH, substance use, serious mental illness, Alzheimer’s/dementia & other BH needs (ADHD, eating disorders, etc.)
• Within Medicare, these members have claims cost over 2x of members without BH needs
• Within Medicaid, these members have claims costs over 7x of members without BH needs

               

The BH Leader will lead a transformative effort to define our future-state operating model for Behavioral Health to improve health outcomes, reduce medical costs, enhance operational efficiency, reduce provider/member abrasion, and improve compliance across Medicare and Medicaid.

Ultimately, this person is responsible for developing and deployment of a new, end-to-end Behavioral Health model at Humana, balancing access, affordability, and health outcomes.

This role plays a pivotal part in enhancing the overall quality of healthcare services, improving our efficiency and effectiveness in delivering behavioral health care, fostering strong relationships with our internal and external stakeholders, and meeting state and federal expectations. 

The BH Leader will work with a dedicated executive governance committee with balanced representation across Medicare and Medicaid. The team will consist of 3-5 BH experts reporting into the BH leader. They will also have an aligned DRI from each member of the governance team – this person will be accountable for the initiative’s success from the POV of their functional / operational area.

Key Responsibilities

• Develop and execute an enterprise-wide behavioral health strategy that sustainably improves behavioral outcomes for our members across insurance segments (Medicare and Medicaid)
• Establish key metrics of success for this strategy and measure progress against them. Metrics should be inclusive of quality, access, and financial metrics, such as medical trend reduction and administrative costs.
• Collaborate with partners across the enterprise to develop, articulate, implement, evaluate, and refine a set of strategic initiatives that address, but are not limited to, the following domains:
  • Access: Ensure Humana members with behavioral health needs have access to appropriate and high-quality behavioral health care by optimizing network design, benefit design, care management, and referral pathways.
  • Medical Cost Management and Outcomes: Characterize the impactable drivers of poor outcomes and avoidable spending for members with behavioral health needs. Identify and implement cost-effective strategies to address impactable drivers of poor outcomes and avoidable spending for members with behavioral health needs to drive medical trend reductions and improve outcomes
  • Analytics and Measurement: Evolve enterprise approach to behavioral health outcome measurement to improve our ability to identify trends, highlight areas for improvement, establish tactics for advancing outcomes, and evaluate the impact of our strategic initiatives. Work collaboratively with enterprise teams to evaluate and synthesize data to inform clinically appropriate, cost-effective solutions to advance the behavioral health management of members.
  • Internal Operations and Technology: Support efforts to improve the efficiency of health plan operations (utilization management, claims payment, provider contracting) to reduce friction for members, providers, and associates.
  • External Partnerships: Explore, evaluate, and implement novel partnerships—with national and community-based organizations—that will expand Humana’s ability to impact behavioral health outcomes.
  • Innovation: Support behavioral health innovation including increasing access to virtual and specialty care and advancing value-based payment models.

• Establish and maintain external relationships to ensure awareness of leading-edge innovation and policy changes in behavioral health; represent Humana and Humana’s behavioral health strategy in external venues

• Opportunity Formulation Define target state for behavioral health at HUM, including key success metrics, with input from key stakeholders Size opportunity for BH program advancement at HUM Assess key developments and trends in BH across Medicare & Medicaid – including 1, 3, 5, 10-year evolution.
• Current State Assessment INTERNAL: Assess HUM current-state; document baseline of key metrics across Medicare and Medicaid, key strengths / opportunities, decision rights
• EXTERNAL: Assess external current-state, including peer org approaches to BH and small / mid-size vendor landscape Summarize key people, process, technology, org structure, and other requirements to deliver on target state.
• Operating Model Recommendation Identify and define options for how to close capability gaps. Build / buy / vend assessment as needed.

Execution

• Execute new operating model, ensuring continuity of work-in-progress activity and longer-term strategies. Effectively transition work to other teams as appropriate

Key Candidate Qualifications

• Bachelor's degree required-Master's degree preferred
• Track record of identifying & rectifying broken processes & systems with a passion for transformative change.
• Expertise in healthcare operations, technology solutions and process optimization
• Excellent and straight forward communication, collaboration, and problem-solving abilities coupled with the ability to tell the story and manage conflict at all levels of the organization
• Strategic and data-driven mindset with proficiency in data analysis tools and working knowledge of financial evaluation as well as M&A processes with experience with integrating acquisitions preferred
• Excellent organizational and project management skills; able to track and manage complex enterprise processes and initiatives from start to finish
• Experience managing external consulting partner from strategy development to execution
• Strong understanding of BH conditions, protocols and health care delivery models.

Behavioral Competencies

• Executive Presence and Team Leadership. A proven leader who inspires and influences cross-functional teams. Has an innate ability to teach and gain followership at all levels. Able to translate high level corporate objectives into actionable objectives for team members. Can challenge, prioritize and clarify company direction.
• Embrace Innovation. Future-oriented, challenges conventions, and anticipates opportunities and trends. Inspires teams with visions and possibilities; embraces learning new skills and new ways of doing things.
• Strong Communicator. Strong, compelling voice with stakeholders across and outside the company. Able to inspire, create followership and gain alignment, purpose driven mentality and approach.
• Results Driver. Decisive and action oriented; executes the business strategy through disciplined prioritization, execution & operational excellence; sets clear targets and puts in place processes, systems and cadences to deliver performance and scale.
• Business Builder and Strategist. A leader who has the intellectual capacity to shape a compelling vision, develop and execute an end-to-end, future-oriented digital acquisition strategy that can both create new and scale existing services and solutions leveraging Humana capabilities and assets.

Use your skills to make an impact
 

HUMANA VALUES

Integral to the success of Humana’s strategy are the values it has established for the organization. These serve as a guide in how business is conducted both internally and externally.

Caring: Create an environment where people feel valued, respected, and are treated with kindness.

Curious: Work and learn together, creating the best solutions for the people served.

Committed: To fulfill its purpose, take bold action to impact the lives of people and transform the healthcare industry.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Application Deadline: 07-30-2025

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.

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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.