Associate VP, Care Management - Medicaid

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $184.8k - $254.1k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Vice President

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Provide strategic and operational leadership for multidisciplinary care and service coordination programs serving Indiana Medicaid members, primarily the Indiana PathWays for Aging population • Own the care and service coordination strategy for Indiana Medicaid and align priorities, resources, and operating plans with market, segment, and enterprise objectives • Provide executive oversight of care coordination, complex case management, service coordination, transitions of care, interdisciplinary care teams, and support functions • Build integrated operating models across physical health, behavioral health, social needs, Medicare, LTSS, HCBS, nursing facility, and community-based services • Advise executive leadership on clinical operations, risks, contractual performance, workforce capacity, member outcomes, and program improvement • Represent care and service coordination in State-facing discussions, audits, readiness reviews, governance forums, and executive meetings • Oversee screening, assessment, reassessment, individualized care planning, service planning, authorization coordination, outreach, and documentation • Ensure engagement of members and informal caregivers and promote coordination among members, caregivers, providers, community partners, Medicare plans, and internal teams • Lead LTSS and HCBS care delivery, Medicare-Medicaid benefit coordination, nursing facility and community-based population alignment, and transitions across care settings • Partner with provider, housing, transportation, workforce, and community resources to address service barriers and social drivers of health • Establish organizational structures, decision rights, leadership routines, staffing models, caseload standards, workforce plans, training programs, succession plans, and contingency coverage • Lead and develop a geographically distributed multidisciplinary workforce with approximately 7 direct and 400 indirect reports • Define and monitor operational, productivity, quality, access, transition, documentation, and member outcome measures • Improve reliability through standardized workflows, technology enablement, data integration, automation, and scalable reporting • Ensure compliance with Indiana PathWays, federal and state Medicaid requirements, Humana policies, and accreditation standards • Maintain audit and regulatory readiness; oversee program reviews, performance reporting, care plan quality monitoring, and corrective action plans • Identify, escalate, and mitigate clinical, operational, regulatory, safety, and reputational risks • Partner with medical, quality, utilization management, member services, provider services, compliance, data, reporting, and IT teams • Build relationships with FSSA/OMPP, providers, advocacy organizations, community organizations, caregivers, and other PathWays stakeholders • Monitor delegated and subcontracted functions for performance, quality, and compliance • Report transparently to executives and deliver improvements in member experience, continuity of care, access, quality, operational performance, workforce performance, and financial performance • Report directly to the CMO with a dotted line to the CEO of Indiana Medicaid

🎯 Requirements

• Must reside or be willing to relocate to the state of Indiana • Bachelor's degree in nursing, social work, public health, healthcare administration, business administration, or a related field • Active, unrestricted Indiana registered nurse license or Indiana license as a Master's-level social worker is required • 10 or more years of progressive experience in managed care, Medicaid, care management, service coordination, population health, LTSS, HCBS, complex care, or related healthcare operations • 8 or more years of leadership experience with responsibility for multidisciplinary clinical and non-clinical teams, including leaders of leaders • Demonstrated experience directing large-scale care management, care coordination, service coordination, LTSS, HCBS, or complex population programs • Demonstrated knowledge of Medicaid managed care requirements, clinical operations, quality management, performance improvement, and audit readiness • Experience establishing operating models, staffing plans, performance metrics, management routines, and corrective action strategies • Strong analytical and financial acumen, including the ability to interpret performance trends, identify root causes, and translate data into action • Demonstrated ability to lead through influence across matrixed organizations and communicate effectively with executives, regulators, providers, associates, members, and community stakeholders • Proficiency with Microsoft Office applications and enterprise reporting tools • Commitment to continuously improving member experience, health outcomes, functional independence, and quality of life • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Ability to work from a dedicated space protecting member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Dedicated home workspace arrangement • Remote work arrangement • Occasional travel to Humana offices for training or meetings