VP, Medicaid Clinical Operations

Humana Inc.

Job Overview

Location

Remote Nationwide

Job Type

Full-time

Full Job Description

📋 Description

• The VP, Medicaid Clinical Operations is an enterprise executive responsible for leading Medicaid clinical operations, utilization management, care management/service coordination, and clinical program delivery across Medicaid markets.
• This leader translates Medicaid strategy, market requirements, quality priorities, and regulatory expectations into standardized operating models, scalable workflows, measurable performance outcomes, and ensures operational excellence.
• The role is accountable for operational execution, clinical program performance, workforce productivity, compliance, quality, cost, access, member experience, provider experience, and risk management across complex Medicaid populations.
• The leader partners with Product, Technology, Data, and Analytics teams to ensure Clinical Operations needs are effectively translated into technology requirements and enabled solutions.
• This position is remote, with a strong preference for candidates residing in Tampa, FL or Louisville, KY.
• Key responsibilities include leading Medicaid Clinical Operations, developing and executing Medicaid clinical operations strategies, overseeing utilization management and care management/service coordination functions, and partnering with Product, Technology, Data, and Analytics teams.
• The leader must have a deep understanding of Medicaid programs, state contract requirements, regulatory expectations, integrated care models, LTSS, behavioral health, complex populations, and DSNP coordination.
• The role requires a strong financial acumen, including experience managing budgets, staffing models, productivity, labor efficiency, revenue, margin, and operating performance.
• The leader must be able to lead through ambiguity, influence cross-functionally, manage risk, engage senior stakeholders, and communicate effectively with executive audiences.

🎯 Requirements

• Bachelor’s degree required; advanced degree in nursing, public health, healthcare administration, business administration, social work, or a related field preferred.
• Strongly preferred Clinical license, nursing degree, or other healthcare credential; MD is not required.
• 10 plus years of progressive experience in Medicaid, managed care, clinical operations, utilization management, care management, population health, health services operations, or healthcare transformation.
• 5 plus years leading large, distributed clinical and/or operational teams, including leaders of leaders, through scale, change, and performance improvement.

🏖️ Benefits

• Competitive salary
• Comprehensive benefits package
• Opportunities for professional growth and development
• Flexible work arrangements
• Recognition and rewards for outstanding performance

Skills & Technologies

Remote

Degree Required

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Humana Inc.

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About Humana Inc.

Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.

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