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The Director, Care Management, will 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. They will 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.

Use your skills to make an impact

Required Qualifications

• 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.

Preferred Qualifications

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

Additional Information

• Workstyle: This is a remote position.
• Travel: Up to 35% of travel is required for onsite team engagement meetings at Humana’s Michigan location and other locations, including meetings with MDHHS, community partners, and care teams.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).

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.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• 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. 

$126,300 – $173,700 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

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.