Director National Medicaid Care Management Strategy and Practice

Profile

Description

As Humana's Medicaid membership continues to grow, the National Medicaid Clinical Operations team is expanding our shared services organization to enhance the clinical delivery process. The National Medicaid Director of Clinical Strategy and Practice builds strategies and policy for development, engagement, best clinical practices and processes for the clinical community within the enterprise. The Director of Clinical Strategy has direct responsibility for establishing the Care Management and Chronic Condition Management programs and services utilized across all of Humana's Medicaid markets. The role requires using in-depth clinical knowledge, communication skills, and independent critical thinking skills towards creating criteria, policies, procedures, and employee training to provide the best and most appropriate treatment, care or services for members.

Responsibilities

The National Medicaid Director of Clinical Strategy and Practice directs and leads a team of clinicians who are responsible for establishing policy, governing, and leading implementation of the Care Management model and Chronic Condition strategy across the Medicaid enterprise. Job responsibilities include:


Directing a team of Physical Health and Behavioral Health clinical leaders in fully developing an integrated clinical strategy and model of care that will be utilized across all Humana Medicaid markets;
Serve as the Humana Medicaid Organization subject matter expert and owner for our industry-leading integrated Physical Health and Behavioral Health clinical model, including leading ongoing design of the strategic model that assures the entire Medicaid population receives the highest quality of care;
Developing National and state level Care Management program descriptions, policies, procedures, detailed workflows, and training that adhere to NCQA standards and state-level contractual requirements;
Implementing Care Management and Chronic Condition Management programs and services in new states, including hiring market level clinical leaders, onboarding new staff to support market-based Care Management services, and supporting market Care Management teams in operational oversight for their services;
Provide National Clinical governance oversight and collaborative partnerships with new and existing Medicaid market leaders in deploying Humana's clinical strategy and provide ongoing process improvement support for Care Management practice;
Lead clinical development of specialized Behavioral Health and Physical Health interventions and services for populations with special health care needs;
Establish National and state-level Clinical Operational metrics and provide ongoing consultation to market leaders for assuring operational metrics and state-level clinical requirements are successfully achieved;
Create operational process consistency, standardized services, and alignment across Medicaid for Clinical Care Management practices, Member and Provider-facing materials and services, and Medicaid clinical content delivery.
Direct team of National Centralized Chronic Condition Management and Disease Management staff to provide specialized interventions for conditions such as Substance Use Disorder (SUD/OUD), PTSD, ADHD, Diabetes, Asthma, and other common chronic conditions.


Required Qualifications

*Bachelor's Degree in Clinical or Behavioral Health field required ;

*Registered Nurse or Licensed Social Worker required ;

*7 years of clinical and/or behavioral health leadership experience required ;

*5 years of Managed Care Operations Leadership experience required ;

*2 years of integrated Behavioral Health and Physical Health Care Management strategy development required (or equivalent 2 years of Behavioral Health Care Management leadership can be substituted) ;

*Integrated Medical & Behavioral Health Operating Model knowledge and experience required ;

*Medicaid Behavioral Health background and experience is required ;

*Previous Medicaid knowledge and experience required ;

*2 years developing collaborative partnerships with enterprise cross-functional teams required ;

*3 years of leading large organizational implementations and/or centralized services teams strongly preferred;

*Master's Degree strongly preferred in Clinical, Social Work, or Behavioral Health field.

Additional Information

This role may work remotely from any U.S. location as long as the candidate may work Eastern Standard hours.

Scheduled Weekly Hours

40

Company info

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