Dr. Usha Titus joined the Kerala cadre of the Indian Administrative Service in 1993 after completing her MBBS from CMC Vellore and MD in General Medicine. She served as the District Collector of Palakkad and Kozhikode where she was the first lady to hold charge. She was also the Secretary-in-charge of the Departments of Medical Education, Social Welfare, Non-Resident Keralite Affairs, Environment and Education.
She has served as the Registrar of IIT Madras and as the Vice-Chancellor of Kerala Technological University. In 2010, she was deputed to the Government of India as the Joint Secretary of the Department of Economic Affairs in the Ministry of Finance where she handled the Multilateral Relations Division and contributed to the G20 negotiations between 2010 and 2015. The Government of Kerala appointed her as the Chairperson and Managing Director of ASAP Kerala in February 2021.