Healthcare is rapidly changing, and our members are living longer, often with more chronic conditions. Consumers expect more personalized and holistic experiences from their health partners. Humana's Enterprise Clinical Operating Model (ECOM), is a multi-year strategy with the goal of improving member experiences and health outcomes through better integrating Humana's clinical capabilities, processes, and technology. This role will be instrumental in executing on the vision of ECOM in partnership with leaders and teams across Humana
Responsibilities
The Director, Clinical Management Strategy and Implementation, must be able to continuously seek and incorporate industry best practices as well as novel/innovative high performing models with a primary focus on care management into an ongoing strategic design to ensure organizational goals for care management. The Director must also be able to work closely with business leaders in Care Management to create a prioritized implementation plan, informed by data analytics, and measured by process and outcome metrics aligned to driving business and strategic goals of the organization.
This person must excel in being able to understand and apply the strategic vision of the organization, bring together appropriate stakeholders with delineated roles, structure and scope initiatives with clearly defined metrics of success, and ensure creation of a strategic and operational plan for implementation. They must have healthcare strategy experience, Care management experience, and demonstrated ability to drive a team from strategic development and planning to operational implementation leading to outcomes of success.
Position Responsibilities
Conducts external review of industry care management models (e.g., providers, payers, industry leaders, market disrupters) and recommends CM strategy/model updates iteratively
Ensures clinical strategic priorities are incorporated into the CM model as appropriate: Population specific care management models, Risk stratified care management models, Care management models integrated with providers and other groups that also provide care management services to the member
Development of care management models informed by data analytics.
Drives and helps assess and perform current state and future state analysis in conjunction with operational leaders of Care management and any other dependent business leaders.
Collaborates with data analytics teams to identify data/information reporting needs, collect necessary data, analyze data and identify trends to improve organizational performance and clinical outcomes related to Care management.
Able to identify and create key milestone and/or deliverables and timeline for strategic and implementation plan, linked to ensuring metrics of success of initiative are achieved
Quickly identifies root cause issues that can delay or derail development/implementation success; actively seeks resolution within organization in a collaborative fashion; and raises concerns to senior leadership along with recommendations for options / solutions
Work with appropriate Governance team to articulate plans, barriers, solutions, etc.
Utilizes a comprehensive, standardized approach to address workflow optimization and adoption through industry based tools or processes.
Uses a system-wide focus to contribute to clinical process discussions and works to achieve system-wide consensus.
Drives innovation towards best practices in clinical areas
Provide subject matter expertise as it relates to the delivery of health services
Provides a source of continual new insight in area of expertise by remaining active in professional societies, national organizations, etc.
Requirements
Must be a licensed RN
Bachelor's degree minimum
8 to 10 years of related experience with evidence of increasingly responsible management experience.
3 - 5 yrs working experience with integrating data analytics to inform strategic design and implementation plan
Demonstrated ability to lead teams and achieve metrics of success including expected outcomes
Understands the foundational elements and able to utilize tools of population health management
Experience with strategy development and execution
Excellent communication and interpersonal skills
Executive presentation skills and ability to communicate with all levels.
Demonstrated ability to build and maintain strong and strategic business relationships
Strong problem-solving and critical-thinking skills with the ability to operate and drive progress with limited information and ambiguity.
Persuasive, collaborative business acumen with the ability to influence others.
Demonstrated ability to manage multiple priorities and delegate accordingly
Demonstrated ability to work in a fast-paced working environment
Knowledge of basic information technology policies, procedures and best practices - must be willing to learn new technologies and techniques.
Are well-respected within the organization and maintains a positive attitude.
Strong action orientation with a can do attitude; ability to make things happen.
Detail orientated and driven by results
Highly organized and able to manage day to day details in an independent fashion without prompting
Preferred
Master's degree
Experience working at healthcare consulting firm, IE BCG, McKinsey etc.
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