Lead, Medicaid Technology

📋 Description

• • As the Lead for Medicaid Technology at Humana, you will be at the forefront of driving comprehensive technology delivery for our critical Medicaid initiatives. This pivotal role demands a strategic vision and hands-on execution to ensure the successful implementation of complex use cases across a multitude of horizontal platform owners. You will be instrumental in ensuring all technological solutions not only meet but exceed stringent regulatory requirements and align seamlessly with enterprise architecture standards, safeguarding compliance and operational excellence.
• • You will serve as the primary technology liaison and point of contact for all Medicaid-related endeavors. This involves orchestrating and fostering robust cross-functional collaboration among diverse teams, including business stakeholders, IT specialists, and external partners. Your leadership will be key in delivering solutions that are not only compliant and scalable but also innovative, positioning Humana at the leading edge of healthcare technology.
• • A core responsibility is owning and evolving the technology roadmap specifically for Medicaid. This roadmap must be meticulously crafted to align with dynamic state and federal mandates, ensuring Humana remains agile and responsive to the ever-changing landscape of healthcare regulations. You will proactively partner with business leaders to translate intricate Medicaid program requirements into clear, actionable technology strategies and solutions.
• • You will play a crucial role in assessing the feasibility of state-specific requirements, working collaboratively with the business to influence and shape these requirements when necessary, ensuring they are both achievable and beneficial for Humana's operational goals and member services.
• • Your expertise will be vital in coordinating efforts across various horizontal platforms, including but not limited to Eligibility, Enrollment, Claims, Provider Management, Pharmacy, and Data Management. This cross-platform integration is essential for the successful implementation of Medicaid-specific use cases, ensuring a cohesive and efficient operational flow.
• • You will drive the critical initiative of interoperability between Humana's core platforms and any third-party vendor systems. This ensures seamless and secure data exchange, which is paramount for accurate reporting, efficient operations, and enhanced member experiences.
• • Leading the execution of high-priority initiatives is a key facet of this role. This includes managing the timely delivery of solutions for new state requirements, critical regulatory mandates, and other strategic projects, with a strong focus on proactive risk mitigation.
• • You will be responsible for overseeing comprehensive testing strategies, encompassing end-to-end testing, release validation, and connectivity assessments. This rigorous approach guarantees that all implemented solutions are compliant, performant, and reliable.
• • Establishing and maintaining robust governance frameworks is essential. This includes defining clear processes for decision-making, issue escalation, and the tracking of key performance metrics across all IT workstreams related to Medicaid.
• • A significant aspect of your role will involve identifying, assessing, and proactively resolving technology risks that could potentially impact go-live timelines or operational stability. This includes managing risks related to integration performance, audit file processing, and other critical system functions.
• • You will be tasked with developing and implementing effective contingency plans to address unforeseen challenges and ensure business continuity. Transparent and timely communication of status, risks, and mitigation efforts to executive stakeholders will be paramount.
• • Championing modernization efforts is a key strategic objective. You will explore and advocate for the adoption of cutting-edge technologies such as APIs, cloud capabilities, and data fabric solutions to significantly improve operational efficiency, enhance scalability, and drive innovation within the Medicaid technology ecosystem.
• • This role requires a deep understanding of managed care platforms, eligibility and enrollment systems, and the complex web of regulatory compliance inherent in the healthcare industry, particularly within Medicaid programs.
• • You will leverage your expertise in cross-platform integration and data governance to ensure data integrity, security, and accessibility across all Medicaid-related systems.
• • The ability to manage complex stakeholder relationships, build consensus, and drive alignment across diverse business and IT teams is critical for success in this role.
• • You will be expected to demonstrate a proven track record of successfully delivering complex IT initiatives within a highly regulated environment, showcasing your ability to navigate challenges and achieve desired outcomes.
• • Your excellent communication, negotiation, and organizational skills will be essential for effectively leading teams, managing projects, and influencing stakeholders at all levels.
• • Experience in driving strategic alignment and integrating disparate teams into cohesive, high-performing units is highly valued.
• • Familiarity with modern, cloud-based architectures and API frameworks will be instrumental in driving technological advancements.
• • A solid understanding of insurance products, benefits administration processes, and key healthcare industry standards will provide a strong foundation for this role.