Associate VP Utilization Management

Charlotte, NC, United States

Description

Home Solutions Division of Humana is seeking an experienced healthcare leader to join our team as Associate Vice President, Utilization Management. The associate will play an integral role in proliferating Humana's proprietary utilization management model(s), specific to homecare services, and will utilize clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.

Responsibilities

Humana is a $77 billion (Fortune 41) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.

Against that backdrop, we are seeking an experienced healthcare leader to join our team as Associate Vice President, Utilization Management for the Value-Based Division within Humana's Home Solutions organization. The AVP, Utilization Management will play an integral role in proliferating Humana's proprietary utilization management model(s), specific to homecare services, across the country.

Specifically, the AVP, Utilization Management will partner with Humana Retail market leaders and provider partners to (1) oversee existing operations, inclusive of >2M members entering 2022, and (2) prioritize the expansion of Humana's homecare utilization model(s). Specific to existing operations, the Associate VP, Utilization Management will oversee a leadership team and utilize their clinical knowledge, communication skills, and independent critical thinking towards interpreting criteria, policies, and procedures to ensure associates are advising on the best and most appropriate treatment. Specific to market expansions, the AVP, Utilization Management will facilitate and track implementation in new expansion markets inclusive of market and provider engagement, hiring and training. The AVP, Utilization Management will continue to monitor markets post-implementation and provide a continuous improvement approach to optimize outcomes, efficiencies and associate experience.

This role will act in both an operational and strategic capacity requiring innovation and collaboration to influence Humana's continued focus on expanding the quality of care that can be provided in the home setting. In addition, this person will act as representative of the division and establish relationships with external partners who may be valuable resources for supporting our business goals, or viable solutions to business challenges that have been identified.

Key Responsibilities will Include:

Oversight and accountability for the UM organization by setting strategic goals and objectives for the UM organization

Participation in the development of short-term and long-term strategic plans required for ongoing growth and success

Provision of thought leadership in the formation of the UM homecare strategy that moves traditional utilization management from a transactional approach to value incorporating decision support, automation, risk management and provider experience

Develop and foster strong working relationships and communication at all levels of the organization

Develop and regularly communicate key operational metrics that systematically measure performance versus plan against medical costs and trends

Develop a communication channel that acknowledges performance improvement in the organization

Ensure the highest standards of efficiency and stakeholder experience for clinical service operations and processes

Proactively build and maintain solid relationships with the Provider community by influencing decision making and ensuring quality and satisfaction standards are met

Develop a comprehensive plan designed to address operational improvement opportunities, including a strategy for market-leading performance

Use data and analytics to inform decision about what current strategies are producing value for member, Provider and Humana

Required Qualifications:

The successful candidate will possess a bachelor s degree in business or health administration

10 years progressive, related business management experience in a high-impact role with track record of success leading regional or national operations of managed care and/or healthcare services

Prior experience overseeing a medical management/clinical services organization desired, with a track record of creating new strategies that support utilization management

Demonstrated leadership capacity to assume oversight and accountability for the operations of a growing business and the ability to lead and motivate people to achieve agreed-upon results.

Extensive capacity to think strategically, effective communication skills and a proven track record of building and maintaining multiple successful partnerships

Proven ability to effect change and meet business goals, monitor progress, and take corrective actions when necessary

Experience working proactively with all stakeholders to identify and meet their needs and requirements

Comprehensive knowledge of managed care operations and how they can work to improve quality of care and reduce costs, including core operations, network management, provider relations and medical management/care management. A deep understanding of clinical service operations

Proven ability to understand business strategies and formulate concise solutions to complex problems. Prior experience of leveraging analytics in business decision

Strong manager of organizational talent who actively seeks to build, manage, and continuously improve the organizational talent of the company

Exceptional written and verbal communication skills. Experience in effectively simplifying and presenting complex information

Strong analytical and critical thinking skills. Focus on driving disciplined, fact-based decisions, and executing with discipline and urgency

Success in simplifying and rationalizing UM, clinical assets and technology offerings based on market value and true return on investment

Preferred Qualifications:

Clinical background

Licensed RN or MD

Master s degree in business or health administration

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

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