Job Details

Clinical Strategy Manager - Utilization Management

Company name
Humana Inc.

Jersey City, NJ, United States

Employment Type

Manager, Business Development

Posted on
Apr 20, 2023

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Job Information


Clinical Strategy Manager - Utilization Management


Jersey City

New Jersey


The Clinical Strategy & Analytics team is a multi-disciplinary team focused on creating data-driven strategies to transform our business and the experiences we create for our members, provider partners & associates. We partner closely with our operations partners, working hand-in-hand to translate these strategies into concrete roadmaps that will generate tangible value to all stakeholders.

Within Utilization Management, our goal is to enable members to receive the most appropriate type of care as quickly as possible ... all while streamlining processes for our provider partners and reducing unnecessary costs from the healthcare system.

Our team employs a rigorous process to set specific business priorities, identifies the greatest sources of value, and leads a multi-disciplinary process to identify discrete opportunities for enhanced clinical outcomes, cost control, quality, and member experience.

This role would be a great fit if ...

You are driven by the opportunity to use your strong strategic and analytical acumen to drive impact and create significant measurable value.

You are passionate about collaboration and partnering across the enterprise (e.g., Clinical Operations, Markets, Utilization Management, Clinical Strategy & Analytics, Pharmacy, Advocacy, etc.) to develop pragmatic, high-value strategies and drive exceptional operational execution of our key objectives.

You are curious - you enjoy connecting the dots between business metrics and frontline, understanding key root causes for what we see in data, testing hypotheses for what we could improve to drive value, and transforming ideas into action.


The Clinical Strategy Manager will analyze complex problems and issues related to utilization management using data and insights from internal and external sources. This role will also bring expertise or identify subject matter experts in support of multi-functional efforts to identify, interpret, and produce recommendations and plans.

This role is highly collaborative and will work closely with associates and executive leaders from across the enterprise to solicit input, guide data-backed problem solving, and make recommendations to advance utilization management strategy. Ultimately, they will work with operational owners to translate strategic recommendations to execution plans for implementation.

The Clinical Strategy Manager will:

Engage in ambiguous problem solving and strategy setting

Use data and insight from experts to identify the greatest opportunities in clinical outcomes, quality, cost, and experience for members/providers/associates in utilization management programs

Lead cross-functional teams to define discrete opportunities that are both impactful and achievable

Work directly with cross-functional partners across the enterprise to create the execution model and roadmap to capture prioritized opportunities

#LI -Remote

Required Qualifications

Bachelor's degree with 6 plus years of experience OR Master's level degree with 4 plus years of experience in driving and creating strategy and/or operations experience

Previous experience in strategy consulting, commercial, business strategy, clinical and operational area and/or related roles

Ability to interpret and leverage data and analytics to improve strategy and make recommendations; ability to complete analysis and modeling of data to drive insights and recommendations for strategy advancement

Experience leading cross-functional group of leaders/teams and initiatives

Strong communication skills both verbal and written, with ability to flex to different audiences, including senior leadership

Proven skills influencing others and a track record of success leading through ambiguity

Proven organization, planning and prioritization skills to collaborate with multiple enterprise departments and stakeholders; ability to execute within deadlines

Passionate about impacting high-needs population health outcomes and social determinates of health

Ability to work independently to manage projects to achieve objectives

Competency with Microsoft Office suite (PowerPoint, Excel)

Preferred Qualifications

Exposure or experience with clinical operations and/or utilization management

Health care industry

Additional Information

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Why Humana? You'll experience the following perks as a full-time Humana employee:

Compensation and Financial Security -

Our pay philosophy is designed to motivate and reward associates for their skills and contributions to the company. We provide options to help you plan for your future and protect your assets: Competitive base pay, Recognition pay, 401(k) retirement savings plan (125% match for the first 6% contributed by an associate), etc.

Your Whole Health -

Humana's health products and services are designed to encourage personal wellness and smart healthcare decisions for you and your family: Medical, dental, and vision benefits, Health plan incentives, Paternity leave, etc.

Work Perks -

Humana knows your life extends outside of work. We have many options to support your interests and needs. Some departments have the flexibility to allow associates to work from home, and we offer all associates: Paid time off, holidays, volunteer time, jury duty pay, Associate charity matching program, Discount programs with major retailers, etc.

Grow With Us -

Humana provides growth and career opportunities that can help you develop your skills and build your future with the organization: Internal and external learning events, Tuition assistance, Inclusion and diversity training, etc.

Social Security Task:

Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from with instructions to add the information into the application at Humana's secure website.

Interview Format:

As part of our hiring process for this opportunity, you may be utilizing our interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Modern Hire interview. In this interview, you will receive a set of interview questions over your phone and you will provide recorded or text message responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours


New York City Pay Range

The compensation range represents a good-faith estimate of starting pay at the time of posting and may vary based on geographic location and/or employment type. Individual pay decisions will vary based on demonstrated job-related skills such as education, experience, certifications, etc.

$135,000 - $185,775

Pay Type



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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our

Company info

Humana Inc.
Website :

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