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

The AVP, Complex Care will lead clinical strategy and opportunity assessment around new value-based opportunities and programs that directly address the complex needs of seniors and improve health outcomes and avoidable utilization (e.g., palliative care, post-acute care, transitions of care) at a population level. This leader will oversee program development, implementation, evaluation, and iteration of current care management programs and new programs or partnerships in areas as above, building the complex care portfolio out to radically improve outcomes and utilization for our seniors nationally. This role will partner with senior clinical and operational leadership, finance, analytics, operations, training, and other relevant teams to build out the portfolio, execute programs, and iterate towards improved effectiveness.

As a key leader on the national clinical leadership team, this role will build executive team engagement and alignment around programs in collaboration with PCO Chief Medical Officer. In addition, the successful leader will establish robust program impact and clinical / medical trend value creation frameworks and lead the team to expanding and deepening impact for the PCO, as new programs are developed and implemented.

Major Duties and Responsibilities

• Create new and innovative strategies and approaches for seniors’ complex care and needs, by developing value-based care models and programs that improve across whole-person care, quality, and total cost of care.
• Coordinate interventions to prevent adverse events such as avoidable ER visits, hospitalizations, readmissions, procedures/surgeries, complications, and mortality, in parallel lowering costs of care.
• Provide direction and support to local markets and centralized teams to ensure engagement, care and service program effectiveness and efficiency.
• Collaborate with CMO, Executive and Divisional leaders, thought partners, and key stakeholders to evaluate new opportunity spaces, bringing a data-driven approach, robust modeling and planning, and execute alignment on new program opportunities.
• Track and monitor population health and clinical program performance data, feedback, and trends to drive continuous program improvement.
• Identifies problems and process improvement strategies to enhance the delivery of care for patients throughout the continuum of care, including develop plans for corrective action in areas identified for improvement.
• Develop, review, and implement program policies and procedures.
• Maintain awareness of key performance indicators/metrics and manages caseload through appropriate management of medical expenses.
• Build a culture of clinical excellence, outcomes commitment, and robust process support, including adherence to evidence-based practice and program operational frameworks.
• Manage clinical and non-clinical team including planning, assigning, directing work, and evaluating team and individual performance.
• Understand market conditions, CMS, and state regulations and policy changes to set a value-based care roadmap and plan.

Required Qualifications

• MD/DO with a combination of clinical training and strategy consulting (e.g., top tier consulting or internal strategy experience, residency in a related field with practice experience)
• 5-7 years post-graduate experience including direct experience leading clinical program development, implementation, and assessment in population health at a multi-region / national scale.
• Hands-on experience and familiarity with complex care management and programs in valued-based care, senior care, and/or Medicare.

Knowledge/Skills/Abilities/Competencies Required

• Expertise in understanding of population health and full-risk frameworks, including patient engagement, clinical professional skillsets, utilization management, care management, clinical information systems, with strong financial acumen and focus.
• Strong leadership skills with the ability to build and lead high-performing teams.
• Must have a passion for improving health outcomes in economically sustainable ways; clinical innovation and care model development.
• Understanding and comfort with population clinical, quality, and financial drivers in full risk care delivery, ideally in Medicare/seniors.
• Ability to execute strategic planning and alignment across a diverse set of senior stakeholders.
• 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.
• 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, presentation creation, 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.

Use your skills to make an impact
 

Working Conditions 

Role can be based anywhere but ideally in or adjacent to a market where our Humana/CenterWell primary care group operates or have hubs in.  Ability to engage in periodic travel (1-2x per month) for market engagement and team meetings.

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.

$265,500 – $365,200 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.