Director of CM, Transplant & Bariatric – Louisville

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.



Role: Clinical Innovations Director
Assignment: Director of Operations, Case Management, Transplant and Bariatric
Location: Louisville, KY

Are you a fit?
Are you innovative and enjoy defining strategy? Would you enjoy using your business knowledge to lead teams to create and maintain programs that align local strategy with larger business objectives? If this describes you, then read on!

Assignment Capsule
As a Clinical Innovations Director you will lead and manage strategy and Human Capital to develop and implement integrated Clinical programs which are value added.

• Develop and manage programs that reach measurable qualitative and financial metrics
  
• Recruit and develop talent, facilitating good team and succession planning
  
• Participate in an integrated fashion with other areas of Clinical activity
  
• Maintain strong, working relationship with internal stakeholders
  
• Design and develop new initiatives within case management program for process improvement and communicating recommendations for change to senior leadership
  
• Interface with acute, chronic, and wellness domain leaders in the evaluation and creation of initiatives to support clinical program improvements
  
• Operationalize new clinical strategies presented by clinical strategy or Humana and CGO business processes
  
• Direct the case management quality initiatives including business performance indicators and analysis of program results in conjunction with program leadership team. This includes department accreditation or certification for URAC and NCQA case management core standards and utilization process impacted by case management
  
• Assure CM department preparation for ISO registration and ongoing process improvement efforts to align with ISO standards
  
• Direct oversight for departmental communications efforts such as responding to RFPs, providing informational presentations to internal/external customers, working with marketing department to develop communication materials, etc
  
• Conduct monthly, quarterly and annual analysis/ review of case management department metrics and operational reporting package. This includes offering recommendations to impact clinical metrics.
  
• Direct supervision of the Case Management Regional Process Managers who serve as regional/market operational leaders
  
• Representation of case management program in leadership, regional, marketing, customer or professional associating meetings. This will include development of presentation materials
  
• Development and submission of staffing models to assure case management coverage and support staff to assure quality delivery of case management services to commercial members

• Builds Human Capital: You deliver current, direct, complete and actionable feedback to associates to support continuous learning and growth; while ensuring that diverse perspectives are widely held, modeled and promoted. By selecting, deploying, developing and rewarding diverse talent, you are able to foster Humana's strategy and meet business requirements.
  
• Acts Strategically: You foster a consistent understanding of strategy, translate it into defined plans, and "stay the course" to implement it, while anticipating and identifying where change is needed.
  
• Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.
  
• Leadership: You inspire extraordinary results by: engaging associates, valuing diversity and shaping culture to support a high performance environment.

• Bachelor's Degree or higher in nursing or business-related field require
  
• Knowledge of Case Management process, including staffing ratios, practice guidelines and staff development
  
• Proficiency in analyzing and inter
  
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