Associate VP, Care Management - Medicaid

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide strategic and operational guidance for multidisciplinary care and service coordination initiatives aimed at Indiana Medicaid members, focusing primarily on the Indiana PathWays for Aging demographic.

• Own the strategy for care and service coordination within Indiana Medicaid, ensuring alignment of priorities, resources, and operational plans with market, segment, and enterprise goals.

• Offer executive oversight for care coordination, complex case management, service coordination, transitions of care, interdisciplinary care teams, and support functions.

• Develop integrated operating models that encompass physical health, behavioral health, social needs, Medicare, LTSS, HCBS, nursing facilities, and community-based services.

• Advise executive leadership on clinical operations, risks, contractual performance, workforce capacity, member outcomes, and opportunities for program enhancement.

• Represent care and service coordination in discussions with state officials, audits, readiness reviews, governance forums, and executive meetings.

• Supervise screening, assessment, reassessment, individualized care planning, service planning, authorization coordination, outreach, and documentation processes.

• Promote member and informal caregiver engagement while facilitating coordination among members, caregivers, providers, community partners, Medicare plans, and internal teams.

• Lead care delivery for LTSS and HCBS, coordinate benefits between Medicare and Medicaid, align nursing facility and community-based populations, and manage transitions across care settings.

• Collaborate with providers, housing, transportation, workforce, and community resources to tackle service barriers and address social determinants of health.

• Establish organizational structures, decision-making rights, leadership routines, staffing models, caseload standards, workforce plans, training initiatives, succession plans, and contingency coverage policies.

• Lead and cultivate a geographically dispersed multidisciplinary workforce consisting of about 7 direct reports and 400 indirect reports.

• Define and track operational, productivity, quality, access, transition, documentation, and member outcome metrics.

• Enhance reliability through standardized workflows, technological enablement, data integration, automation, and scalable reporting solutions.

• Ensure compliance with Indiana PathWays, federal and state Medicaid regulations, Humana policies, and accreditation standards.

• Maintain audit and regulatory readiness; oversee program reviews, performance reporting, care plan quality monitoring, and corrective action strategies.

• Identify, escalate, and mitigate risks related to clinical, operational, regulatory, safety, and reputational aspects.

• Collaborate with medical, quality, utilization management, member services, provider services, compliance, data, reporting, and IT teams.

• Foster relationships with FSSA/OMPP, providers, advocacy organizations, community organizations, caregivers, and other PathWays stakeholders.

• Monitor the performance, quality, and compliance of delegated and subcontracted functions.

• Provide transparent reports to executives while driving improvements in member experience, continuity of care, access, quality, operational performance, workforce performance, and financial outcomes.

• Report directly to the CMO and have a dotted line to the CEO of Indiana Medicaid.

⛳️ Requirements

• Must be a resident of or willing to relocate to Indiana.

• Bachelor's degree in nursing, social work, public health, healthcare administration, business administration, or a related discipline.

• An active, unrestricted Indiana registered nurse license or Indiana Master's-level social worker license is mandatory.

• A minimum of 10 years of progressive experience in managed care, Medicaid, care management, service coordination, population health, LTSS, HCBS, complex care, or similar healthcare operations.

• At least 8 years of leadership experience overseeing multidisciplinary clinical and non-clinical teams, including leaders of leaders.

• Proven experience in directing large-scale care management, care coordination, service coordination, LTSS, HCBS, or complex population programs.

• In-depth knowledge of Medicaid managed care requirements, clinical operations, quality management, performance improvement, and audit preparedness.

• Experience in establishing operating models, staffing strategies, performance metrics, management routines, and corrective action plans.

• Strong analytical and financial skills, with the ability to interpret performance trends, identify root causes, and convert data into actionable insights.

• Proven capability to lead through influence within matrixed organizations and communicate effectively with executives, regulators, providers, associates, members, and community stakeholders.

• Proficient in Microsoft Office applications and enterprise reporting tools.

• Commitment to continuously enhancing member experience, health outcomes, functional independence, and overall quality of life.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload.

• Ability to work from a designated space that ensures the protection of member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on overall company and/or individual performance.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• 401(k) retirement savings plan.

• Paid time off.

• Company-observed holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance policy.

• Dedicated home workspace arrangement.

• Remote work options available.

• Occasional travel required to Humana offices for training or meetings.