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…