Associate VP, Care Management-IN Medicaid

Become a part of our caring community The Associate Vice President, Care Management provides strategic and operational leadership for multidisciplinary care and service coordination programs serving Indiana Medicaid members, with primary accountability for the Indiana PathWays for Aging population. This leader is responsible for integrated care coordination, complex case management, service coordination, transitions of care, interdisciplinary care teams, and related population health operations across physical health, behavioral health, long-term services and supports (LTSS), and home and community-based services (HCBS). The AVP translates Medicaid contract requirements and enterprise strategy into reliable operating models, measurable performance, and person-centered outcomes. The role requires an in-depth understanding of how clinical, operational, quality, regulatory, financial, technology, and provider capabilities interrelate across the market and enterprise. The AVP must continuously maintain the Indiana clinical license required by the contract. This position reports directly to the CMO with a dotted line to the CEO of Indiana Medicaid. It has 7 direct reports and roughly 400 indirect reports. Strategic and Executive Leadership Own the care and service coordination strategy for Indiana Medicaid and align program priorities, resources, and operating plans with market, Medicaid segment, and enterprise objectives. Provide executive oversight of care coordination, complex case management, service coordination, transitions of care, interdisciplinary care team activities, and care management support functions. Build an integrated operating model across physical health, behavioral health, social needs, Medicare, LTSS, HCBS, nursing facility, and community-based services. Advise market executive leadership on clinical operations, emerging risks, contractual performance, workforce capacity, member outcomes, and opportunities for program improvement. Represent care and service coordination in State-facing discussions, audits, readiness reviews, governance forums, and cross-functional executive meetings, as appropriate. Person-Centered Care and Service Coordination Ensure programs consistently apply person-centered, strengths-based, culturally responsive, and trauma-informed practices that reflect member goals, preferences, risks, functional needs, and chosen living setting. Oversee timely and accurate screening, comprehensive assessment, reassessment, individualized care planning, service planning, authorization coordination, member outreach, and documentation. Ensure members and informal caregivers are meaningfully engaged in planning and supported with education, choice, decision-making, and access to community resources. Promote interdisciplinary care team collaboration and closed-loop coordination among members, caregivers, providers, community partners, Medicare plans, and internal teams. Advance initiatives that support aging in place, community integration, caregiver support, and appropriate diversion from or transition out of institutional settings. LTSS, HCBS, and Medicare-Medicaid Integration Provide executive leadership for LTSS and HCBS care delivery, including service coordination, service plan implementation, member monitoring, and escalation of access or safety concerns. Ensure effective coordination across Medicaid and Medicare benefits for dual-eligible members, including collaboration with D-SNP and Medicare clinical operations. Oversee operational alignment for nursing facility and community-based populations, including member choice, continuity of care, functional needs, and waiver or patient liability considerations. Partner with provider, housing, transportation, workforce, and community resources to address barriers to services and social drivers of health. Ensure smooth transitions among hospitals, nursing facilities, HCBS settings, providers, Medicaid programs, and coverage types, with timely transfer of clinical and authorization information. Operational Excellence and Workforce Leadership Establish accountable organizational structures, clear decision rights, and effective leadership routines across care and service coordination functions. Develop and maintain staffing models, caseload standards, workforce plans, training programs, succession plans, and contingency coverage that support contractual performance and continuity of operations. Lead and develop a geographically distributed, multidisciplinary workforce that may include nurses, social workers, behavioral health professionals, service coordinators, community health workers, transition staff, housing resources, quality staff, and operational support teams. Define and monitor operational and productivity measures, including timeliness, caseloads, outreach, assessment and care plan completion, documentation quality, service access, transitions, and member outcomes. Reduce manual work and improve reliability through standardized workflows, technology enablement, data integration, automation, and scalable reporting. Ensure leaders use performance data to identify root causes, implement corrective actions, and sustain improvement. Quality, Compliance, and Audit Readiness Ensure compliance with Indiana PathWays contract requirements, applicable federal and state Medicaid requirements, Humana policies, and relevant accreditation standards. Maintain continuous readiness for State, external quality review, regulatory, accreditation, and internal audits, including complete documentation and timely remediation of findings. Partner with Compliance, Quality Improvement, Medical Leadership, Utilization Management, Legal, and Market Operations to interpret requirements and implement compliant processes. Oversee care plan and service plan quality monitoring, program reviews, performance reporting, and corrective action plans. Ensure staff and delegated partners receive required initial and ongoing training, including person-centered practices, population-specific needs, clinical protocols, cultural competency, health equity, privacy, fraud and abuse, and job-specific contract requirements. Identify, escalate, and mitigate clinical, operational, regulatory, member safety, and reputational risks. Cross-Functional and External Partnership Partner closely with the Medical Director, LTSS Program Manager, Care Coordination Manager, Service Coordination Manager, Behavioral Health Manager, Quality Improvement, Utilization Management, Member Services, Provider Services, Compliance, Data and Reporting, and Information Technology. Build effective relationships with FSSA/OMPP, providers, advocacy organizations, community-based organizations, informal caregivers, and other stakeholders supporting the PathWays population. Collaborate with provider-facing teams to address access gaps, strengthen HCBS capacity, improve transitions, and reduce avoidable administrative burden. Ensure delegated and subcontracted functions are monitored for performance, quality, and compliance, with clear accountability and timely issue resolution. Performance Expectations Deliver reliable compliance with assessment, care plan, service plan, member contact, transition, and reporting requirements. Improve member experience, continuity of care, access to services, and achievement of person-centered goals. Demonstrate measurable improvement in quality, operational, productivity, workforce, and financial performance. Maintain transparent executive reporting, clearly assigned ownership, timely escalation, and disciplined follow-through on corrective actions. Balance member-centered decisions with contractual accountability, clinical quality, operational feasibility, and responsible stewardship of resources. Use your skills to make an impact Required Qualifications Must reside or 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 to 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. Preferred Qualifications Master's degree in nursing, social work, public health, healthcare administration, business administration, or a related field. Experience with Indiana Medicaid, the PathWays for Aging program, or another Medicaid managed LTSS program. Experience serving older adults, people with disabilities, dual-eligible members, nursing facility residents, and members receiving HCBS. Experience with Medicare-Medicaid integration and Dual Eligible Special Needs Plans. Experience with NCQA Health Plan accreditation, case management standards, and LTSS Distinction. Experience leading regulatory audits, readiness reviews, corrective action plans, or external quality reviews. Experience improving clinical operations through workflow redesign, automation, data integration, and performance reporting. Additional Information Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay 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. $184,800 - $254,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. 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