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

The Chief Operating Officer (COO) establishes long‐range goals, objectives, and plans and monitors financial and operational performance. They will be responsible for the strategic development and oversight of operations for Humana’s Michigan Medicaid Plan. They will manage ongoing operations across multiple levels of the organization to meet operational Contract requirements and financial performance goals. They will be accountable for operational results. The COO represents the plan externally and to State and external agencies.

POSITION RESPONSIBILITIES:

• Directs and coordinates day‐to‐day plan functions, including Reporting, Claims Administration, Encounter Data Quality, Grievance and Appeals, Information Technology and Systems, Member Services, Provider Services, and Business Continuity Planning and Emergency Coordination
• Liaise among MDHHS, plan leadership, and corporate contacts responsible for the execution of Contract deliverables
• Works with the plan Chief Executive Officer to maintain important stakeholder relationships throughout Michigan
• Leads internal infrastructure to review and improve operational functions
• Manages implementation of strategic plans developed in cooperation with the Plan leaders
• Oversees development and maintenance of operational policies and procedures
• Effectively implements business plans and oversees audit processes
• Owns execution of daily operating objectives and goals, including key performance metrics
• Plans organizational growth and potential staff successions
• Develops and cultivates a diverse and inclusive environment
• Maintains intimate familiarity with Contractual requirements and stipulations
• Understands and actively manages ongoing adherence to local, State, and federal regulatory and programmatic requirements
• Mitigates risks potentially impacting the State of Michigan and the plan by proactively monitoring any risk factors and red flags that may arise during operations
• Communicates with MDHSS and direct plan/corporate leadership regarding any necessary operational or regulatory changes
• Leads conflict resolution for any Provider relations or network issues that may occur

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree
• 8 or more years of health plan experience, preferably in Medicaid
• 8 or more years of leadership experience with direct reports
• Health insurance and/or government program expertise
• Deep technical and financial understanding of health plan operations and reporting
• Experience leading departmental activities to ensure accurate and timely accounting, financial and statistical reports
• Prior experience developing methods and criteria for measuring and summarizing data for complex analyses
• Strong strategic mindset and execution skills
• Highly collaborative attitude and excellent relationship building skills
• Ability to lead and manage special projects that may necessitate cross-functional partnerships
• Solution oriented and experienced in conflict resolution
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• This position is located in Michigan.

Preferred Qualifications

• Master’s degree
• Experience in Medicare and Duals
• Certified Public Accountant
• Strong provider contracting, credentialing and/or relations experience
• Solid understanding of claims and encounter management
• Ambitious entrepreneurial mindset

Additional Information

• Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.
• Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:
  
  Health benefits effective day 1
  Paid time off, holidays, volunteer time and jury duty pay
  Recognition pay
  401(k) retirement savings plan with employer match
  Tuition assistance
  Scholarships for eligible dependents
  Parental and caregiver leave
  Employee charity matching program
  Network Resource Groups (NRGs)
  Career development opportunities

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$203,400 - $279,800 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

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.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.