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Humana Associate Director (Autism Care Demonstration) in Troy, Michigan



The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider experience, as well as optimizing operational processes. The Associate Director will lead design and implementation of the process and experience for the ACD (Autism Care Demonstration) policy changes. Develop and monitor performance and quality of initiatives, providing insight and recommendations to the ACD leaders. The Associate Director will oversee major process changes, be responsible for overarching project planning and deliverables for the ACD team, work with vendors, as needed.

Humana Government Business government contract requires U.S. citizenship for this position .


35 % Lead team to identify, develop, document and execute operational efficiency projects, as well as all impacts for Change Orders, for ACD Program Integrity Audit; driving to operational excellence, repeatable processes and output of clean, useable data for further analysis, ensuring CDRL requirements are met and delivered timely.

25 % Motivate team to work with ACD Program Integrity leadership, develop new, or change program deliveries to support trend opportunities or business needs. Includes documenting and delivering all details of staffing needs, process flow, system needs, data needs, provider audit compliance etc.

20 % Develop deep process & data flow documentation for all programs; that becomes working document and basis for changes, training, desk-level procedure documentation. Additionally, manage and maintain ACD Dashboard ensuring accuracy in reflection of full ACD team performance.

10 % Create a roadmap to align work with departmental and corporate strategy direction. Coach and mentor team; focused on customer experience, continuous improvement, change management, data integrity and process-level measurements.

10% Working with ACD Care Management operational leaders, lead development of meaningful QIPs (Quality Improvement Plans) that meet DHA expectations and measure outcomes (i.e. claims data) vs. members in a program. As well as to research & resolve beneficiary & provider complaints and grievances as they relate to the ACD.

This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives.

Required Qualifications

  • Experience in healthcare or in a managed care setting

  • 3 plus years of people leadership experience to include demonstrated experience in development and motivation

  • Prior experience with healthcare fraud investigation

  • Experience with Microsoft Office products for business presentations including; Word, Excel, PowerPoint, Visio and/or Project

  • Expertise and experience in project management, program management, problem solving and issues mitigation

  • Excellent verbal and written communication and PC skills

  • Demonstrated success in planning and implementation of across-the-board process improvement initiatives, including both tactical and strategic-level projects

  • A full and effective confidence of process improvement tools and methodologies and metrics commonly used

  • Our Department of Defense Contract requires U.S. citizenship for this position.

  • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Work at Home Requirements

  • Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work

  • Must provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

  • Prior experience with the TRICARE Autism Care Demonstration

  • Bachelor's degree in business, accounting, systems management or related field

  • Lean; Six Sigma Certification

  • Prior experience with Care Management operations support

Additional Information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours