Humana Medicaid Implementation Advisor - Clinical in PNC, United States


The Clinical Market Development Advisor provides support to existing and new Medicaid implementations. The Market Development Advisor works on problems of diverse scope and complexity ranging from moderate to substantial. Critical thinking is required and this position is responsible for driving and managing all Clinical Medicaid Projects.


New Business Development

  • As a representative of the Medicaid Implementation team, provide strategic leadership from a Clinical Program perspective as we evaluate market entry strategies in pipeline markets and respond to Requests for Proposals for new lines of business.

  • Participate in the RFP Response process along with the Business Development team working closely with Clinical leaders to shape the Clinical Strategy and commitments.

  • Evaluate new and innovative opportunities and programs and work across the Medicaid leadership team to develop a plan to implement them.

New Business Implementation

  • Clinical Implementation Lead for new lines of business. Responsible for executing on the Clinical Component of all new business implementations, which includes:

    -Leading the development of Clinical requirements where there are IT impacts and partnering with the BA to write the VSR. -Leading the identification of all other impacts (process, staffing, etc.). Work with other clinical leaders on the execution. -Responsible for tracking the program/project plan for all clinical components. -Lead Clinical work stream through Readiness Review.

Current Market Support and Clinical Technology Oversight

+ Attend Local market Operating Committees

+ Develop relationships with Corporate and Market Clinical Leaders.

+ Strategically evaluate clinical programs across all markets.

+ Continuous focus on process improvement - opportunities for alignment, process changes to introduce synergies, eliminating waste, ensuring changes in one market don’t adversely affect other markets, etc.

  • Serve as a point of escalation for necessary Program or Technology changes that require Corporate support.

  • Manage the Clinical Technology development Roadmap partnering with HCS and IT.

  • Responsible for prioritization at the Project/Program/Major Feature level.

Ensure compliance with CMS and State Medicaid regulations.

Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Required Qualifications

  • Bachelor's degree

  • 3 - 5 years experience with Medicaid/Medicare operations/healthcare experience

  • 3 - 5 years managing large scale projects and cross functional teams

  • Success in developing working relationships within a highly matrixed business environment

  • Ability to analyze data and make informed recommendations

  • 3-5 years experience managing and facilitating with the ability to influence without having authority.

  • Act as a thought leader with strong verbal and written communication skills (ability to interact effectively with people at all levels within a team or internal division).

  • Strong critical thinking, problem solving skills; detailed and well organized.

  • Demonstrates accuracy and thoroughness, identifies process improvements; fosters quality in others.

  • Accepts responsibility, is self-motivated and accountable for achieving implementation and market satisfaction goals.

  • Works within deadlines, demonstrates independence, resourcefulness and self-management skills.

Preferred Qualifications

  • Master's degree

  • Experience responding to state and/or federal government solicitations

  • Knowledge of Humana’s internal policies, procedures and systems

Additional Information

Scheduled Weekly Hours


About Us

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact for assistance.

Humana Safety and Security

Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact to validate the request.