KEY RESPONSIBILITIES
•Leadership & Operational/Organizational Management:
•Proven experience in clinical operations and financial management, including P&L responsibilities.
•Proficiency in monitoring and analyzing key performance indicators (KPIs) such as Membership, Retention, Patient Engagement, Access, Scheduling, Referral turnaround time, phone abandonment rates, PCP/voluntary alignment change forms, and more.
•Monitor and manage data analytics, scorecards, cost & utilizations, HCC coding, and NPS Scores, focusing on patient satisfaction and performance improvement.
•Supervision and management of operational staff and guiding them on performance expectations, managing daily schedules, and supporting organizational change management.
•Engage in recruitment, development of internal leaders, and fostering continuous learning and improvement.
•Ensure team of healthcare professionals are trained in the principles and practices of Value Based Care (VBC).
•Responsible for contributing to leadership and financial discussions during monthly meetings with Market CAs and Regional AMD, utilizing exceptional presentation and facilitation skills to simplify complex information and engage audiences.
•Demonstrates strong financial acumen and managing Profit & Loss (P&L) to connect strategy with business results
•Collaborates with Community Engagement Professionals and Providers to develop and execute growth tactics within the center and community. Prioritizes centers for targeted growth investments.
•Evaluates performance of all operational staff directly reporting.
•Ensures accuracy of all supply ordering, invoices, and expense submissions as well as management of VSP resources.
•Ensure all standard operating procedures are adhered to within the center and all compliance required signage is visible in patient-facing areas and back-office to include breakrooms.
•Ensure growth targets and financial levers are understood and being met
•Understand and support center incident reporting and maintenance/facility needs
•Represent CenterWell/Conviva brands in community and media activities while collaborating with the recruitment team to build and network a pipeline of high-quality primary care clinicians (physicians, APPs, MAs, and other clinical professionals)
Clinical/Patient Experience:
•Experienced in managing outpatient care teams to maintain high patient satisfaction and strong brand in the community.
•Ensures centers are focused on obtaining and managing Google reviews.
•Ensure high levels of patient satisfaction by addressing clinician performance issues and fostering a patient-centric environment and culture of care.
•Focus on patient outcomes and integrate VBC principles into daily operations.
•Collaborate with providers on patient terminations in collaboration with compliance.
•Conduct monthly safety audits, manage MSDS and OSHA concerns, and address clinic operation opportunities.
•Ensures Center Administrators are addressing patient service recovering as needed and any clinician concerns are discussed with AMD to define any action.
•Collaborate with providers on patient terminations in compliance with regulations
•Maintains awareness of the competitive health care environment and escalates any issues.
•Ensures centers are completing monthly audits of payor directories to ensure providers within the center are accurately represented. Escalate necessary changes to Market President.
Dyad Partnership:
•Collaborate with the Associate Medical Director to achieve shared goals, ensuring consistent communication and unified decision-making.
•Align on performance management, clinical and operational strategies, growth (sales and retention) tactics, and present a unified voice to respective teams.
•Partner on operational budgeting and strategic planning, determining services, providers, and expected outcomes collaboratively.
•Focus on utilization management and review provider schedules to meet patient access goals, with biannual reviews of incentive plans.
•Monitor and communicate incentive and performance plans effectively.
•Collaborate to manage performance/disciplinary issues, either within the clinical or operational team.
•Ensure patient access across all centers overseeing balancing new patient access and acute needs for existing patients.
Required Qualifications
•Must be able to work at the CenterWell Care clinic
•5+ years of management experience in clinical care or related field, with experience driving results in a full-risk VBC environment.
•Strong understanding of healthcare regulations, compliance, and managed care.
•Skilled in EMR systems, DataHub, NPS, and other relevant software tools.
•Job is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. Candidates selected for this job will be required to be screened for TB.
•Current CPR certification
•Associates working in the State of Florida will need ACHA Level II Background clearance.
•Must have a valid driver’s license as there will be travel between centers.
•Proven interpersonal skills with the ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives, medical groups, IPA's, community organizations and other health plan staff.
•Demonstrated interpersonal skills, enabling effective interaction both internally and externally with a diverse range of individuals, including physicians, office staff, hospital executives, medical groups, IPAs, community organizations, and other health plan staff.
•Candidates selected for this job will be required to adhere to Humana’s flu vaccine policy.
Preferred Qualifications
•Bachelor's degree or equivalent experience preferred. Degree preferably in Business administration Healthcare Administration, or a related field; or, in lieu of a bachelor’s degree, 10+ years of Healthcare
•Basic knowledge of Population Health and how it comes to life in a global risk primary care environment
•Familiarity with Medicare and Risk model
•Experience managing a budget of $1M+
Scheduled Weekly Hours
40Pay 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.
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.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.