**Become a part of our caring community and help us put health first** The National Director, Care Integration Strategy & Program will be responsible for the end-to-end program effectiveness to build and establish operational and strategic goals and objectives consistent with PCO Strategic Initiatives. Will lead and oversee the strategic planning, development, and execution of initiatives aimed at optimizing patient care transitions across the primary care continuum. The incumbent will play a pivotal role in reducing acute care utilization for top 5% of complex patients and ensuring seamless transitions of care for patients within the Primary Care Organization (PCO), hospital systems, and other patient care facilities that ultimately improve care standardization and resource utilization, reduce readmissions and enhance/optimize patient outcomes, satisfaction, and operational efficiency. Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M’s framework as well as transitions of care, best practices to guide policy and procedure development derived from the best evidence practices. Provide ongoing program support through active communication, education, and consultation with clinical staff and leaders. Responsible for communicating with key stakeholders across the organization while creating communications and coordinating statistics and analysis of data to track and trend for the purpose of improving programmatic and performance on issues related to reducing acute care utilization, safe transitions, readmission reduction, and other clinical programs as determined. The National Director, Care Integration Strategy & Program is a critical leadership role responsible for the success of the portfolio of Care Integration programs within the Complex Care vertical of centralized programming to serve CenterWell Senior Primary Care’s (and Conviva Senior Primary Care’s) highest need and complexity patients with care and case management services. The Director is response for the strategic direction, execution and ongoing management of our High Risk Patient Management (HRPM) program, Transitions of Care Management (TCM) program, and Episodic Consult (single-use case specific offerings) programs designed to improve quality and reduce costs for high-risk senior populations in full-risk Medicare arrangements. The Director will lead and oversee the strategic planning, development, and execution of initiatives aimed at optimizing patient care transitions across the primary care continuum. This leader will play a pivotal role in reducing acute care utilization for the top 5% of complex patients and ensuring seamless transitions of care for patients within the Primary Care Organization (PCO), hospital systems, and other patient care facilities that ultimately improve care standardization and resource utilization, reduce readmissions and enhance/optimize patient outcomes, satisfaction, and operational efficiency. The leader will be responsible for ensuring programs coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management via the 5M’s framework as well as transitions of care and other guideline, workflow and procedure development derived from the evidence-based practices. Working in a highly matrixed environment, the Director will collaborate closely with clinical, operations, analytics, medical economics, technology, and finance teams to optimize program delivery and drive measurable outcomes. The ideal candidate will possess a strong strategic and program operator background (particularly with a lens toward VBC provider delivery offerings), a deep understanding of value-based care principles, and a proven ability to lead and motivate cross-functional teams. This leader will provide ongoing program support through active communication, education, and consultation with clinical and operational leaders, and is responsible for engaging with key stakeholders across the organization while creating communications and coordinating data analysis and insights to track and trend for the purpose of improving programmatic performance on issues related to reducing acute care utilization, safe transitions, readmission reduction, and other clinical programs as determined. Portfolio scope + High Risk Patient Management Program – Care and case management interdisciplinary offering for top 5% highest need patients + Transitions of Care Management Program – Post acute care management interdisciplinary offering for patients following an acute IP/Obs utilization event + Episodic Consults Program – Unique need (i.e., single resource) offerings for bridging or episodic support for medication management, chronic disease management, deprescribing, behavioral health support + New programming as advance Care Integration strategic plan Key Performance Indicators: + Market Provider and operations team experience of CIT, measured by achieving meaningful patient-provider engagement, improving provider capacity by reducing administrative work related to population health management, and assisting patients with the aim of improving patient outcomes and reducing unnecessary utilization. + Positive associate experience, measured by associate engagement in annual company surveys, turnover rates that are like national benchmarks, and survey responses related to being on the One Care Team serving patients holistically + CIT program impact on high-risk patient populations, measured by decreasing acute and post-acute care utilization to meet or exceed annual benchmarks set by the organization. This must include the ability to drive a team-based approach and work as an interdisciplinary team to assess and develop care plans for complex patients and coordinate care with CenterWell as well as outside providers (hospitals, SNFs, ERs, CBOs) + Excel in CIT operational efficiency measured by meeting or exceeding national benchmarks in operating expense PMPM costs by leveraging technology, data, lean processes, and delegation services where appropriate. Strategic Responsibilities: + Strategy: develop, socialize, and implement clinical program strategy on a page with the capability of identifying short-term and long-term vision and goals in partnership and collaboration with leadership, operational leaders, clinical leaders, IT, population health, and analytics. + Assessment: develop a framework to assess CIT operations, clinical program measurement and performance, and effectiveness from patients’ and clinicians’ perspectives. + Governance and Prioritization: the ability to prioritize work by the organization’s goals and priorities. Relationship management and negotiation skills to ensure clinicians and market leaders feel engaged and respected in CIT and clinical program-related decision-making by partnering with the market and national leaders, developing feedback forums, and creating closed-loop communication channels with stakeholders. Share learnings with other Divisional Directors to standardize national processes to leverage scale. Operational Responsibilities: + People: drive CIT to perform and focus on the organization’s priority efforts—building relationships with market dyads at both divisional and market levels. Empower and enable people leaders within the organization. + Process and Workflows: work with national leadership to standardize the process while also having the ability to partner with center operations and process teams to leverage lean methodology, swim lane diagrams to align on clear roles and responsibilities, and develop ways to improve operating PMPM costs + Technology: the ability to work with EMR, operational and outcome reporting, knowledge of care management tools and assessments, documentation, and how information can be transformed into data to provide information about program performance management. **Working Conditions** This is a Work-At-Home position with 20-40% travel to various CenterWell & Conviva markets, on-site **Work-At-Home Requirements** + Must have the ability to provide a high-speed wireless, DSL, or cable modem (including VPN tunnel) for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. + A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. + Satellite Internet service is NOT allowed for this role. + A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **Use your skills to make an impact** **Required Qualifications:** + Bachelor’s degree + 7+ years progressively responsible professional experience in health-related strategy and operations positions, preferably in value-based care, particularly managed care or full risk models + 5+ years of people leadership experience + 5+ years of project / program leadership experience + The ability to clearly explain complex ideas, analytic insights and technologies to non-technical audiences + Experience in a large, highly matrixed company, with proven ability to influence leaders and key stakeholders in such an environment, within and outside of direct reporting lines + Excellent qualitative and quantitative analytic skills, with the ability to ask the right questions to identify the root causes of problems to be addressed + Excellent collaboration capabilities and high EQ; integrator, can connect the dots and understand how to optimize system-level processes + Curious, quick learner, innovator but data- and evidence-driven + Experience in managing change by leading and energizing others, modeling adaptability, and inspiring strong organizational performance through periods of transformation, ambiguity, and complexity. + Demonstrate excellent relationship-building skills and a high level of skill to build positive professional interpersonal relationship, with proven ability to collaborate + Excellent oral and written communications skills, including the polish, poise, and executive and authentic presence that will ensure effective interaction with regional and market managers, directors, CMOs and Presidents **Preferred Qualifications** + Master of Business Administration with three years experience post Master’s level training, or advanced clinical experience (RN, LCSW, MD/DO, APRN) + Data, product, analytics and impact translator skills to effectively engage cross-functionally in assessing opportunity and feasibility of strategic initiatives + Characteristics of the qualified candidate: + A highly credible leader with deep understanding and empathy for the clinician and patient pain points in day-to-day panel management + Excellence communication skills, including follow-through communication, executive presentations, and the ability to negotiate with horizontal and upward/downward vertical networks + Capable of developing and socializing a strategic plan with all key strategic components, including SMART goals or OKR framework + A passionate advocate for improving clinician and patient experience and effectiveness through panel management (aka population health management) + Comfortable managing influence in the context of multiple operations, development, and deployment initiatives in a matrixed environment **Additional Information** + Remote role, 20-40% travel to various CenterWell & Conviva markets, on-sites 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. $150,000 - $206,300 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 08-20-2025 **About us** About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. ​ **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. Centerwell, a wholly owned subsidiary of 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 full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources