Become a part of our caring community and help us put health first

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.
• 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.

Preferred Qualifications

• Master’s Degree.
• Licensed RN or Licensed Social Worker in the State of Michigan without restrictions.
• Care Management certification (CCM).
• Certified Professional in Health Care Quality (CPHQ).

Additional Information

• Workstyle: This is a remote position.
• Travel: Up to 25% travel to MDHSS, locations across Michigan, including participation in team engagement meetings and conferences both within and outside the state.
• Direct Reports: Up to 8.

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$104,000 - $143,000 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.