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National Director of Transitional Care and High-Risk Patient Management

The Director of Transitional Care and High-Risk Patient Management (TCM & HRPM) will be responsible for the end-to-end program effectiveness to build and establish operational and strategic goals and objectives consistent with PCO Strategic Initiatives. Will lead and oversee the strategic planning, development, and execution of initiatives aimed at optimizing patient care transitions across the primary care continuum. The incumbent will play a pivotal role in reducing acute care utilization for top 5% of complex patients and ensuring seamless transitions of care for patients within the Primary Care Organization (PCO), hospital systems, and other patient care facilities that ultimately improve care standardization and resource utilization, reduce readmissions and enhance/optimize patient outcomes, satisfaction, and operational efficiency.

Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M’s framework as well as transitions of care, best practices to guide policy and procedure development derived from the best evidence practices.

Provide ongoing program support through active communication, education, and consultation with clinical staff and leaders. Responsible for communicating with key stakeholders across the organization while creating communications and coordinating statistics and analysis of data to track and trend for the purpose of improving programmatic and performance on issues related to reducing acute care utilization, safe transitions, readmission reduction, and other clinical programs as determined.

Major Duties and Responsibilities

·       Build and establish end to end operational and strategic goals and objectives consistent with PCO Strategic Initiatives.

·       Formulate and achieve national objectives, goals, and strategies (clinical, economic), integrate practice standards, and collaboratively assess the effectiveness of each program, new opportunities, and develop actionable plans to meet growth and programmatic objectives.

·       Evaluate the progress of programs or services by benchmarking best practices and identifying measurable outcomes, including the effective transitions of care activities and the implementation of the 5Ms framework (Mobility, Mind, Medications, Multi-complexity, and What Matters Most) to address and focus on the whole person, their quality of life.

·       Establish collaborative relationships and work with operational and strategic key stakeholders, including clinical teams and care integration team (CIT) leadership to align on program goals, process/system improvements, and needs.  May facilitate cross- functional performance improvement teams.

·       Assist in developing written policies and procedures and practice protocols pertinent to the transitional care program and high-risk patient management.

·       Build and implement feedback loops and monitoring mechanisms with CIT and market primary care teams, to identify needs and opportunities for program improvement.

·       Create, collect, and coordinate metrics and analysis of data to track and identify any trends or anomalies for the purpose of improving programmatic and performance on issues. 

·       Demonstrate a thorough understanding and use of data systems to drive decisions and plan/implement performance improvement strategies.

·       In certain cases, will oversee and direct sub teams/functions or dotted line sub teams/functions (e.g., outreach function in call center or directly and other related integrated care teams).

·       Produce project work plans, timelines, and reports identifying and communicating key benchmarks for use in evaluation.

·       Devise communication strategies to keep internal and external stakeholders informed of TCM initiatives and programs.

·       Encourage and support innovative approaches to TCM practices in relation to expected standards across the continuum of care and provide ongoing avenues for orientation and continuing education for staff.

·       Collaborate and partner in the execution of TCM workflows and processes to ensure comprehensive patient education programs that assure quality and appropriateness of care across settings (i.e., inpatient, ambulatory, and home).

Use your skills to make an impact
 

Required Qualifications

·       Bachelor or Master’s Degree in Nursing, Social Work, or a related Healthcare professional degree

·       Minimum of 5-7 years of successful leadership experience overseeing a multi-region scale health care management program development and implementation with a focus on care transitions, post-acute care and high-risk management and care coordination.

·       Experience with case management, social work, skilled nursing facilities, rehab programs, etc.

·       Proven ability to move the needle on clinical quality outcomes (e.g., avoidable hospitalizations, ER visits, readmissions, total cost of care, and reducing acute care utilization).

·       Familiarity in integrated care management programs with primary care.

Preferred Qualifications

·       Master's degree in health care administration, business administration or related field.

·       Experience working in a complex value-based health care organization.

Knowledge/Skills/Abilities/Competencies Required

·       Strong leadership skills with the ability to build and lead high-performing teams.

·       Excellent communication and interpersonal skills with the ability to communicate effectively with stakeholders at all levels.

·       Strong analytical and problem-solving skills with the ability to develop and implement metrics to measure the effectiveness of care transitions.

·       Understanding of clinical operations and ability to guide priorities, process development and implementation.

·       Understanding of quality and value drivers in full risk care delivery, ideally in Medicare/seniors

·       Demonstrated ability to work collaboratively with clinical and operational leaders across a complex health care organization.

·       Knowledge of health care regulations and policies related to care transitions and post-acute care management.

·       Computer skills in word processing, database management, spreadsheets, and report writing.

·       Proficiency in tracking and evaluating process/system outcomes and performing and monitoring rapid cycle process improvement.

·       Excellent project and program management skills

·       Demonstrated ability for complex clinical decision making.

Additional Information

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 recommended; 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

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.

$136,200 – $187,400 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 CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.

About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.