Director, CMS & Provider Direct Channel
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Job Description
Director leading Humana's CMS & Provider Direct Channel strategies, including compliance APIs and interoperability capabilities. Focusing on scalable solutions and provider adoption in healthcare.
Responsibilities:
- Lead strategy and execution for the CMS & Provider Direct Channel, including CMS compliance APIs, voluntary interoperability capabilities, and direct-to-provider connectivity.
- Own channel performance across regulatory delivery, provider adoption, and ongoing channel expansion.
- Translate CMS requirements, policy direction, and enterprise priorities into practical channel strategies and executable roadmaps.
- Partner across product, technology, operations, compliance, legal, and business teams to deliver compliant, scalable, and provider-ready capabilities.
- Drive adoption of CMS and direct connectivity solutions by aligning channel capabilities to provider needs and business priorities.
- Oversee execution for provider-facing APIs and direct exchange capabilities that improve access, reduce friction, and enable interoperability at scale.
- Define and manage KPIs for channel readiness, compliance execution, adoption, utilization, and performance.
- Support external engagement tied to CMS mandates, voluntary commitments, and direct provider connectivity opportunities.
- Identify risks, dependencies, and execution barriers early, and drive cross-functional resolution.
- Lead and develop a strong team across channel delivery, partner coordination, and execution management.
- Continuously monitor regulatory change, market movement, and provider demand to strengthen channel performance over time.
Requirements:
- Bachelor’s degree in business, healthcare administration, or a related field
- 6+ years of progressive leadership experience in interoperability, digital health, healthcare technology, product management, regulatory delivery, or related functions, ideally in healthcare
- Experience leading delivery of API-based capabilities, regulatory programs, or provider-facing interoperability solutions.
- Strong understanding of CMS interoperability requirements, healthcare data exchange, provider workflows, and operational execution
- Proven ability to lead across business, compliance, operational, and technology teams
- Demonstrated ability to analyze complex issues, communicate effectively and drive solutions
- Track record of driving execution in complex, cross-functional environments
Benefits:
- 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
- many other opportunities
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