Become a part of our caring community The Program Delivery Lead will lead the strategy, implementation, and operational execution of Medicaid Revenue Optimization and Member Activation programs. This leader will partner across Finance, Market Operations, Risk Adjustment, Care Management, Encounters, Compliance, Market Leadership, Product, and external vendors to ensure members receive benefits for which they qualify while maximizing appropriate reimbursement and revenue opportunities.The role is accountable for program performance, market expansion, vendor governance, stakeholder alignment, and the delivery of measurable financial and operational outcomes. The successful candidate will be an expert at navigating complex Medicaid environments, influencing across matrixed organizations, and translating strategic opportunities into scalable operational solutions.The Program Delivery Lead will lead the strategy, implementation, and operational execution of Medicaid Revenue Optimization and Member Activation programs. This leader will partner across Finance, Market Operations, Risk Adjustment, Care Management, Encounters, Compliance, Market Leadership, Product, and external vendors to ensure members receive benefits for which they qualify while maximizing appropriate reimbursement, revenue, and cost-of-care opportunities.The role is accountable for program performance, market expansion, vendor governance, stakeholder alignment, and the delivery of measurable financial and operational outcomes. The successful candidate will be an expert at navigating complex Medicaid environments, influencing across matrixed organizations, and translating strategic opportunities into scalable operational solutions.Key ResponsibilitiesRevenue Optimization Program LeadershipLead Medicaid revenue optimization initiatives including but not limited to:SSI eligibility identification and conversionsESRD Medicare and non-dual to dual transitionsMember activation and engagement initiativesCondition based solutionsDevelop and execute multi-year program roadmaps aligned with organizational growth objectives.Identify opportunities to improve program performance, financial outcomes, and member engagement and experience.Monitor leading and lagging indicators to proactively manage business performance.Operational ExecutionOversee end-to-end program delivery from strategy through implementation and ongoing operations.Establish operational frameworks, governance structures, KPI reporting, and performance management processes.Remove barriers impacting outreach effectiveness, encounter acceptance, provider documentation, and vendor execution.Ensure program scalability across multiple Medicaid markets.Cross-Functional LeadershipBuild strong partnerships across:FinanceClinical and Care ManagementComplianceProcurementMember and Provider EngagementEncounters OperationsMedicaid Market LeadershipActuarialFacilitate executive-level discussions regarding performance, opportunities, and risk mitigation.Drive accountability across stakeholders to meet program objectives.Vendor ManagementLead strategic vendor relationships supporting member engagement and revenue optimization initiatives.Establish performance standards and monitor contractual outcomes.Evaluate vendor capacity, quality, operational efficiency, and financial value realization.Partner with vendors to develop innovative approaches to improve member activation and program completion rates.Financial Performance ManagementQuantify business opportunities and expected financial outcomes.Develop business cases and ROI analyses for program enhancements and market expansions.Monitor revenue realization, cost structures, forecast performance, and financial risks.Present performance updates and recommendations to executive leadership.Market Expansion & InnovationSupport introduction of programs into new Medicaid markets.Navigate state-specific regulatory requirements and approval processes.Evaluate emerging revenue optimization opportunities and new member engagement strategies.Drive continuous improvement and innovation initiatives.Preferred CompetenciesStrategic LeadershipCreates long-term strategies while maintaining operational rigor.Balances member experience, regulatory requirements, and financial performance.Program Management ExcellenceExpert knowledge of large-scale program delivery methodologies.Demonstrated success managing complex, cross-functional initiatives.Financial AcumenStrong understanding of:Medicaid financingRevenue optimizationBusiness case developmentForecasting and ROI analysisInfluencing & Executive PresenceAbility to influence without direct authority.Comfortable leading discussions with senior executives and market leadership.Data-Driven Decision MakingUses analytics to identify opportunities and drive outcomes.Builds actionable insights from operational and financial performance data.Vendor & Partner ManagementProven ability to hold vendors accountable while maintaining productive partnerships.Change LeadershipSuccessfully leads organizational change and adoption across matrixed teams.Use your skills to make an impact Required QualificationsBachelor's degree5+ years within Medicaid, Medicare, managed care, revenue optimization, risk adjustment, care management, or health plan operations.5 or more years of technical experience2 or more years of project leadership experienceStrong knowledge of Microsoft Office XP products (Word, Excel, Access)Excellent communication skills, both oral and writtenStrong relationship building skillsMust be passionate about contributing to an organization focused on continuously improving consumer experiencesExperience leading enterprise-scale, cross-functional initiatives.Experience with vendor management and performance governance.Strong financial and analytical capabilities.Preferred QualificationsMaster's Degree in Business Administration or a related fieldPMP certification a plusSix Sigma Certification also a plusKnowledge and experience in health care environment/managed careStrong analytical skillsFinance acumenTechnical skill such as Power BI, Databricks, SQLWork 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 Hours40Pay RangeThe 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 year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, 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.Application Deadline: 09-03-2026About 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.​Equal Opportunity EmployerIt 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.