Regional Director, Care Integration Strategy & Program

Regional Director Care Integration Strategy & Program

Become a part of our caring community and help us put health first. The Regional Director builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise. The Regional Director, Care Integration Strategy & Program is a critical leadership role responsible for the success of the portfolio of Care Integration programs within the Central Region to serve CenterWell Senior Primary Care's (and Conviva Senior Primary Care's) highest need and complexity patients with care and case management services. The Director is responsible for the strategic direction, execution and ongoing management of our High-Risk Patient Management (HRPM) program, Transitions of Care Management (TCM) program, and Episodic Consult (single-use case specific offerings) programs designed to improve quality and reduce costs for high-risk senior populations in full-risk Medicare arrangements. The Director will lead and oversee the strategic planning, development, and execution of initiatives aimed at optimizing patient care transitions across the region. This leader will play a pivotal role in reducing acute care utilization for the 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. The leader will be responsible for ensuring programs coordinate quality improvement activities to address high risk, high-utilizers / high-cost patient management via the 5M's framework as well as transitions of care and other guidelines, workflow and procedure development derived from the evidence-based practices. Working in a highly matrixed environment, the Director will collaborate closely with clinical, operations, analytics, medical economics, technology, and finance teams to optimize program delivery and drive measurable outcomes. The ideal candidate will possess a strong strategic and program operator background (particularly with a lens toward VBC provider delivery offerings), a deep understanding of value-based care principles, and a proven ability to lead and motivate cross-functional teams. This leader will provide ongoing program support through active communication, education, and consultation with clinical and operational leaders, and is responsible for engaging with key stakeholders across the organization while creating communications and coordinating data analysis and insights to track and trend for the purpose of improving programmatic performance on issues related to reducing acute care utilization, safe transitions, readmission reduction, and other clinical programs as determined.

Portfolio scope + High Risk Patient Management Program Care and case management interdisciplinary offering for top 5% highest need patients

Transitions of Care Management Program Post acute care management interdisciplinary offering for patients following an acute IP / Obs utilization event

Episodic Consults Program Unique need (i.e., single resource) offerings for bridging or episodic support for medication management, chronic disease management, deprescribing, behavioral health support + New programming as advance Care Integration strategic plan

Key Performance Indicators :

Market Provider and operations team experience of CIT, measured by achieving meaningful patient-provider engagement, improving provider capacity by reducing administrative work related to population health management, and assisting patients with the aim of improving patient outcomes and reducing unnecessary utilization.

Positive associate experience, measured by associate engagement in annual company surveys, turnover rates that are like national benchmarks, and survey responses related to being on the One Care Team serving patients holistically.

CIT program impact on high-risk patient populations, measured by decreasing acute and post-acute care utilization to meet or exceed annual benchmarks set by the organization. This must include the ability to drive a team-based approach and work as an interdisciplinary team to assess and develop care plans for complex patients and coordinate care with CenterWell as well as outside providers (hospitals, SNFs, ERs, CBOs).

Excel in CIT operational efficiency measured by meeting or exceeding national benchmarks in operating expense PMPM costs by leveraging technology, data, lean processes, and delegation services where appropriate.

Strategic Responsibilities :

Strategy : develop, socialize, and implement clinical program strategy on a page with the capability of identifying short-term and long-term vision and goals in partnership and collaboration with leadership, operational leaders, clinical leaders, IT, population health, and analytics.

Assessment : develop a framework to assess CIT operations, clinical program measurement and performance, and effectiveness from patients' and clinicians' perspectives.

Governance and Prioritization : the ability to prioritize work by the organization's goals and priorities. Relationship management and negotiation skills to ensure clinicians and market leaders feel engaged and respected in CIT and clinical program-related decision-making by partnering with the market and national leaders, developing feedback forums, and creating closed-loop communication channels with stakeholders. Share learnings with other Regional Directors to standardize national processes to leverage scale.

Operational Responsibilities :

People : drive CIT to perform and focus on the organization's priority effortsbuilding relationships with market dyads at both regional and market levels. Empower and enable people leaders within the organization.

Process and Workflows : work with national leadership to standardize the process while also having the ability to partner with center operations and process teams to leverage lean methodology, swim lane diagrams to align on clear roles and responsibilities, and develop ways to improve operating PMPM costs

Technology : the ability to work with EMR, operational and outcome reporting, knowledge of care management tools and assessments, documentation, and how information can be transformed into data to provide information about program performance management.

Use your skills to make an impact

Required Qualifications :

Bachelor's degree

7+ years progressively responsible professional experience in health-related strategy and operations positions, preferably in value-based care, particularly managed care or full risk models

5+ years of people leadership experience

5+ years of project / program leadership experience

The ability to clearly explain complex ideas, analytic insights and technologies to non-technical audiences

Experience in a large, highly matrixed company, with proven ability to influence leaders and key stakeholders in such an environment, within and outside of direct reporting lines

Excellent qualitative and quantitative analytic skills, with the ability to ask the right questions to identify the root causes of problems to be addressed

Excellent collaboration capabilities and high EQ; integrator, can connect the dots and understand how to optimize system-level processes

Curious, quick learner, innovator but data- and evidence-driven

Experience in managing change by leading and energizing others, modeling adaptability, and inspiring strong organizational performance through periods of transformation, ambiguity, and complexity.

Demonstrate excellent relationship-building skills and a high level of skill to build positive professional interpersonal relationships, with proven ability to collaborate

Excellent oral and written communications skills, including the polish, poise, and executive and authentic presence that will ensure effective interaction with regional and market managers, directors, CMOs and Presidents

Ability to travel to required markets 20-40% of the time as needed in the Central Region

Preferred Qualifications :

Master of Business Administration with three year's experience post Master's level training, or advanced clinical experience (RN, LCSW, MD / DO, APRN)

Data, product, analytics and impact translator skills to effectively engage cross-functionally in assessing opportunity and feasibility of strategic initiatives

Additional Information

Remote role with 20-40% travel to various CenterWell & Conviva markets, on-sites

Travel : While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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. $150,000 - $206,300 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,