Director, Care Management

Humana • Chittenden, VT

1d • Remote

About The Position

The Director, Care Management, will provide oversight to ensure Humana’s Long-Term Supports and Services (LTSS) care management and contractual performance objectives are met for the Michigan Medicaid program. This role is responsible for ensuring that programs and resources are effectively utilized to achieve short and long-term population health goals. The Director will lead, develop, and operationalize LTSS care management/coordination within Humana's population health strategy, encompassing education, utilization management, and quality improvement activities for the clinical team. Key responsibilities include developing, implementing, measuring, analyzing, and reporting on LTSS programs and initiatives aimed at improving the health and quality of life of Enrollees. The position requires adherence to best practice standards and National Committee of Quality Assurance (NCQA) Care Management criteria for developing documentation tools to achieve impactful Enrollee outcomes. The Director is also responsible for the planning, directing, and successful management of the LTSS Clinical Strategy for The Michigan Department of Health and Human Services (MDHHS).

Requirements

• Must reside in Michigan or be willing to relocate to the state.
• Master’s degree or other advanced degree in nursing, social work, gerontology, health services research, health policy, information technology, or other relevant field.
• An active, unrestricted Michigan RN license or Social Work (SW) license.
• Five (5) or more years of experience working in the Long-Term Social Services (LTSS) industry, including with Home and Community Based Services (HCBS).
• Five (5) or more years of leadership experience leading large teams with proven success in directing and leading these teams.
• Prior work experience with the elderly or disabled population.
• Proven success in team building and training/coaching staff to meet operational requirements and goals.
• Comprehensive knowledge of all Microsoft Office applications, specifically Outlook, Excel, and PowerPoint.
• Proficiency in analyzing and interpreting clinical and utilization trends.
• Thorough understanding of health plan and regulatory rules, managed care, care management, disease management and referral processes.
• Ability to analyze and integrate information and make sound decisions based upon established guidelines.
• Commitment to the creation of a collaborative and supportive work environment.

Nice To Haves

• Certified Case Manager (CCM).
• Certified Professional in Health Care Quality (CPHQ).

Responsibilities

• Provide oversight to ensure the company’s Long-Term Supports and Services (LTSS) care management and contractual performance objectives are met for the Michigan Medicaid program.
• Ensure the program and resources are used effectively and successfully to execute short and long-term population health goals.
• Lead, develop, and operationalize LTSS care management/coordination within Humana's population health strategy, education, utilization management, and quality improvement activities for the clinical team.
• Develop, implement, measure, analyze, and report on LTSS programs and initiatives designed to improve the health and quality of life of our Enrollees.
• Ensure best practice standards and the National Committee of Quality Assurance (NCQA) Care Management criteria are used to assist with developing the documentation tools to create impactful Enrollee outcomes.
• Responsible for the planning, directing, and successful management of the LTSS Clinical Strategy for The Michigan Department of Health and Human Services (MDHHS).
• Ensure application of person-centered thinking, promoting member autonomy and independence.
• Oversee appropriate data sharing between internal and external resources to support whole-person care, continuity of care, and service integration.
• Provides input into functions strategy.
• Lead, mentor, exemplify, and inspire teams responsible for LTSS care management.
• Collaborate with the Chief Medical Officer, Quality Improvement Director, Utilization Director, Population Health Management Director and National Medicaid LTSS Care Management Director to oversee processing of LTSS utilization management requests.
• Oversee the partnership with the Area Agency on Aging (AAAs)and/or other similar agencies to ensure quality of care, provider adequacy, and training, in collaboration with the External Coordination Leader.
• Contribute to the success of associate and Enrollee experience in assigned region as well as across the state/enterprise.
• Develop and implement operational plans to improve LTSS access and service utilization.
• Oversee the assessment and evaluation of Enrollees' needs and requirements to achieve and/or maintain optimal wellness state by guiding Enrollees/families toward and facilitate interaction with resources appropriate for the care and well-being of Enrollees.
• Make decisions typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implement strategic plans, drive goals and objectives, and improve performance.
• Develop and maintain functioning teams to accomplish goals set by the division.
• Encourage professional responsibility and assist with professional development.
• Define key personnel productivity and quality indicators that meet industry standards.
• When necessary, develop and update process improvement plans for internal and external customers.
• Develop education and training programs for LTSS team, inclusive of case review and case study.
• Collaborate with other Humana leadership to identify the clinical tools and systems to support LTSS care management activities.
• Participate in Care Management Collaborative meetings as required by MDHHS.
• Ensure that the Health Services team operates in compliance with state and federal regulations, state Contract requirements, Humana policies and NCQA standards.

Benefits

• Medical benefits
• Dental benefits
• 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 disability
• Long-term disability
• Life insurance
• Bonus incentive plan

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees