Care Management Program & Strategy Coordinator – Care Delivery Organization – WAH

Humana

Description

Be a part of the CDO Partners in Primary Care leadership team, a subsidiary whose purpose is to provide care management program support resources to physicians, physician groups, and integrated healthcare delivery systems throughout the country.

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Partners in Primary Care, a division of Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Partners in Primary Care, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.

The Care Management Program & Strategy Coordinator is responsible for working with appropriate departments in the areas of compliance, process improvement, and member/provider satisfaction for all product lines. The Care Management Program & Strategy Coordinator work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

In addition the Care Management Program & Strategy Coordinator is responsible for enterprise wide strategy in clinical quality areas in order for consistent approach across business lines. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Responsibilities

Humana’s Care Delivery Organization is seeking a professional to be on the national leadership team. This role is key in assisting in supporting the operational execution strategy of the Care Management program activities in all existing, new and expansion markets. This role will support areas of operational development and performance improvement in existing programs related to, nurse care management, integrated behavioral health, pharmacist, and social services support. The main responsibilities of the role are:
Develop a comprehensive knowledge of Humana’s Care Delivery Organization strategy, best practices and tools
Support process improvement opportunities and any development and implementation of the solutions
Participate and coordinate with technology team to ensure technology supports clinical workflows
Reviews and supports opportunities for automation, analytics, and services to improve and support program production, quality and financial targets
Assist in streamlining clinic workflows, processes, and standard operating procedures
Review and identifies opportunities based on operational reporting and metrics to ensure adherence to clinic strategy and operational efficiencies
Assist in implementation of team workflows, job aides, audit tool development, tracking of training activities
Conducts workflows reviews / audits to identify opportunities for both individual and overall organizational process improvement
Assist to train all new market ancillary resources and ensure that local market trainers are proficient to train on all required elements
Assist in development of delegation program activities which include ensuring compliance with all regulatory related requirements (NCQA, CMS, etc) Includes: development of internal auditing / monitoring program and to ensure all aspects of operations is compliant
Assist in researching and the development of clinical practice guidelines and to ensure operational workflows alignment with those guidelines
Develop, implement and manage quality checks and auditing of workflow and clinical documentation for process improvement purposes
Coordinates in a matrixed reporting structure to complete job tasks
Collaborates w/ various levels of team members and leaders across the organization to improve clinic operational effectiveness
Supports implementation of all related policy and procedures required to ensure operational stabilization and compliance with all federal, state, and local requirements

Required Qualifications
Clinical related degree or healthcare related field
Strong program and project management skills
Proven record and experience the ability to facilitate groups to achieve performance objectives
2+ years health solutions system experience in the areas of Population Health Management and/or care management program development and management
Broad understanding of integrated team based models and programs in a primary care setting
Strong Medicare industry and value based risk models
Ability to promote collaboration among inter-dependent functions as a fundamental tenet of the Humana culture, and critical to the success of our business strategy
Effectively meet and exceed customer needs; build productive relationships with physicians, internal customers, and takes responsibility for customer loyalty and satisfaction
Work effectively and cooperatively with other members of the CDO Team; establishing and maintaining good working relationships. Must have strong team orientation and collaboration. Seek to achieve common goals that contribute to the overall success of the organization.
Demonstrate interpersonal/verbal communication skills
Strong consultation and influencing skills
Ability to multi-task and work in a fast paced environment with changing priorities
Comprehensive knowledge of Microsoft Office applications, including Word, Excel and Access
Ability to travel up to 50%

Desired Qualifications
LPN, RN, Family Practice or Geriatric Nurse Practitioner
Extensive (ideally 5+ years) operational development experience in healthcare markets or a similar integrated care business entity – specifically center based operations experience
Experience with internal monitoring programs and delegation oversight management
Broad provider-centric business experience in a variety of clinical operating environments (physician practices, clinics, groups) with exposure to different clinical models (Staff, IPA, PHO, Home-based, etc.)
Prior experience within a managed care environment, and experience with multiple products (Medicare, Medicaid Duals, Commercial Group/Individual) is strongly desired

Additional Information

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Modern Hire interview. In this interview, you will read to a set of interview questions and you will enter/text responses to each question. You should anticipate this interview to take about 10 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.

Scheduled Weekly Hours
40

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