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Humana SC Medicaid Market Director in Lancaster, South Carolina


The Director, Market Leadership (COO) establishes long-range goals, objectives, and plans; monitors financial and operational performance. He/she will be responsible for the strategic development and oversight of operations for Humana's South Carolina Medicaid plan. They will manage ongoing operations across multiple levels of the organization to meet operational contract requirements and financial performance goals. They will be accountable for operational results. Represents the health plan externally and to governmental/external agencies.


  • Direct and coordinate day-to-day plan functions, including reporting, claims administration, encounter data quality, grievances and appeals, information technology and systems, program integrity and regulatory compliance, member services, provider services, and business continuity planning and emergency coordination

  • Liaise between the South Carolina Department of Medicaid (SCDHSS), plan leadership, and corporate contacts responsible for the execution of contract deliverables

  • Work with the plan CEO to maintain important stakeholder relationships throughout South Carolina

  • Lead internal infrastructure to review and improve operational functions

  • Manage implementation of strategic plans developed in cooperation with the plan CEO

  • Oversee development and maintenance of operational policies and procedures

  • Effectively implement business plans and oversee audit processes

  • Own execution of daily operating objectives and goals, including key performance metrics

  • Plan organizational growth and potential staff successions

  • Develop and cultivate a diverse and inclusive environment

  • Maintain intimate familiarity with contractual requirements and stipulations

  • Understand and actively manage ongoing adherence to local, state, and federal regulatory and programmatic requirements

  • Mitigate risks potentially impacting the state of South Carolina and the plan by proactively monitoring any risk factors and red flags that may arise during operations

  • Communicate with ODM and direct plan/corporate leadership regarding any necessary operational or regulatory changes

  • Lead conflict resolution for any provider relations or network issues that may occur

Reporting Relationship :

This position will be report directly to the South Carolina Medicaid President.

Required Qualifications

  • Bachelor's degree in Business, Operations Management, Healthcare Administration or related field

  • Minimum two (2) years of experience in health plan management

  • Four (4) to six (6) years of experience working in healthcare operations

  • Leadership background with more than five (5) direct-reports

  • Residence in South Carolina with frequent travel to Columbia area required

Preferred Qualifications

  • Master's degree

  • Experience responding to state and/or federal government solicitations

  • Medicare Dual Eligible Demonstration experience

  • Medicaid health plan experience in strategic and thought leadership

  • Medicaid Long term care experience

Additional Information

Scheduled Weekly Hours