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The Associate Director, Care Management, will provide oversight to ensure Humana’s Long-Term Services and Supports (LTSS) care management and contractual performance objectives are met for the Michigan Medicaid program. They will ensure the program and resources are used effectively and successfully to execute short and long-term population health goals.

• Leads, develops, and operationalizes LTSS care management/coordination within Humana's population health strategy, education, utilization management, and quality improvement activities for the clinical team.
• Develops, implements, measures, analyzes, and reports on LTSS programs and initiatives designed to improve the health and quality of life of our Enrollees.
• Ensures 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).
• Ensures 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.
• Leads, mentors, exemplifies, and inspires 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 the processing of LTSS utilization management requests.
• Oversee the partnership with AAAs and/or other similar agencies to ensure quality of care, provider adequacy, and training, in collaboration with the External Coordination Leader.
• Contributes 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.
• Makes 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 implements strategic plans, drives goals and objectives, and improves performance.
• Develop and maintain functioning teams to accomplish goals set by the division.
• Encourages professional responsibility and assist with professional development.
• Defines key personnel productivity and quality indicators that meet industry standards.
• When necessary, develop and update process improvement plans for internal and external customers.
• Develops education and training programs for LTSS team, inclusive of case review and case study.
• Collaborates with other Humana leadership to identify the clinical tools and systems to support LTSS care management activities.
• Participates in Care Management Collaborative meetings as required by MDHHS.
• Ensures that the Health Services team operates in compliance with state and federal regulations, state Contract requirements, Humana policies and NCQA standards.

Use your skills to make an impact
 

Required Qualifications

• Must reside in or be willing to relocate to the state of Michigan.
• Master’s degree or other advanced degree in nursing, social work, gerontology, health services research, health policy, information technology, or in a related field.
• Five (5) or more years of experience working in the Long-Term Social Services (LTSS) industry.
• 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.
• Comprehensive knowledge of all Microsoft Office applications, specifically Outlook, Excel, and PowerPoint.
• Proven success in team building and training/coaching staff to meet operational requirements and goals.
• 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.
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