Clinical Strategy and Program Development Lead

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The Clinical Performance Strategy & Measurement Team shapes how Humana defines, measures, and improves clinical performance across the enterprise. By identifying high-impact opportunities to improve healthcare quality, affordability, provider performance, and member outcomes, the team informs enterprise strategy and drives meaningful change across the healthcare ecosystem. At its core, the team's mission is to ensure Humana measures what matters, enabling targeted actions that help members receive higher-value care, achieve better health outcomes, and support a more affordable healthcare experience.

The Clinical Strategy and Program Development Lead develops and advances enterprise clinical strategies that improve healthcare quality, affordability, provider performance, and member outcomes. As part of the Clinical Performance Strategy & Measurement Team, this role identifies and evaluates high-impact opportunities, assesses performance gaps, and develops clinical performance frameworks and quality measures that enable the organization to define, track, and improve performance across the enterprise.

Partnering across clinical, analytics, operations, network, and business teams, the Clinical Strategy and Program Development Lead translates complex data and insights into business cases, strategic recommendations, and investment priorities that drive measurable clinical and business value. The role operates within a strategy-to-execution model, helping move enterprise priorities from opportunity identification through implementation, measurement, adoption, and sustained impact.

This position plays a key role in shaping Humana's long-term clinical performance strategy by identifying emerging opportunities, developing strategic roadmaps, advancing innovative measurement approaches, and creating scalable solutions that deliver sustainable enterprise value.

Clinical Strategy & Opportunity Development

• Identify and evaluate opportunities to improve clinical performance across priority populations and specialties through data analysis, measurement gap assessment, and development of performance frameworks and quality measures.
• Conduct strategic assessments of clinical performance and measurement gaps to identify improvement opportunities and advance enterprise priorities.
• Conduct specialty landscape analyses and identify gaps in performance, measurement, and enterprise capabilities to inform future investment decisions.
• Develop business cases, strategic recommendations, and adoption approaches for new clinical initiatives.
• Develop and maintain strategic roadmaps that prioritize future clinical performance opportunities and align investments with enterprise objectives.
• Own and maintain a pipeline of future clinical performance opportunities aligned to enterprise priorities.

Measurement & Performance Improvement

• Develop clinical performance frameworks, quality measures, and measurement strategies to evaluate outcomes and drive improvement.
• Partner with clinical, analytics, and business leaders to ensure performance measures align with organizational objectives and support meaningful action.
• Collaborate with cross-functional teams to identify improvement opportunities, establish success metrics, and evaluate results.
• Support governance processes related to clinical performance measurement and prioritization.

Strategic Leadership & Collaboration

• Build strong partnerships across clinical, operational, analytics, network, and business teams.
• Present recommendations and influence executive decision-making.
• Lead cross-functional initiatives that improve quality, cost, and member outcomes.

Innovation

• Monitor industry trends and emerging best practices.
• Identify opportunities to expand enterprise clinical capabilities and deliver long-term value.

Use your skills to make an impact

Role Essentials

• Bachelor's degree

• 8+ years of experience in healthcare strategy, clinical strategy, healthcare consulting, population health, provider performance, value-based care or quality improvement OR 4 years of experience from a top tier consulting

• Experience developing strategic recommendations using quantitative and qualitative data analysis

• Experience leading cross-functional strategic initiatives and driving results across multiple stakeholders

• Experience partnering with analytics teams to analyze healthcare data and generate actionable insights

• Experience developing business cases and presenting recommendations to senior leadership

• Demonstrated ability to influence without direct authority

• Strong executive communication, presentation, and storytelling skills

• Self-starter with the ability to proactively identify opportunities, solve complex problems, and manage competing priorities

• Demonstrated ability to navigate ambiguity and drive results in a fast-paced environment

• Advanced proficiency in Microsoft Excel and PowerPoint

Role Desirables

• Advanced degree (Master's or Doctorate) in Business (MBA), Public Health, Epidemiology, Healthcare Administration, Clinical Informatics, or a related field

• Experience developing business cases, strategic roadmaps, and enterprise-level recommendations for healthcare programs and initiatives

• Clinical degree or licensure (e.g., MD, DO, PharmD, APRN, NP, PA, RN, BSN)
• Knowledge of healthcare claims data, clinical coding systems and taxonomies (e.g., ICD-10, CPT, HCPCS), quality measurement methodologies, performance analytics, and their application to performance measurement and improvement initiatives
• Experience working with Medicare Advantage populations
• Experience synthesizing evidence from peer-reviewed literature, industry research, and healthcare trends to support strategic decision-making

Additional Information

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.$115,200 - $158,400 per yearThis 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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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.

Originally posted on Himalayas