Humana Gold Plus Integrated is looking for Managers of Care Management who will lead teams of nurses, care coordinators and behavioral health professionals responsible for care management. The Manager, Care Management, works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules, and goals. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
The Manager, Care Management supervises, direct and evaluate a diverse group of health care professionals to assure effectiveness of care coordination activities.
- Leads cross-functional collaboration through regular briefings and area meetings; maintains ongoing communication with departmental managers to ensure alignment and operational efficiency.
- Identify members for specific case management and / or disease management activities.
- Monitors case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions.
- Develop system-view recommendations, reports trends and implement appropriate actions to control trends.
- Develop audit plans and tools for teams to ensure compliance with state contracts on performance metrics and to ensure member needs are met.
- Develop reporting tools in collaboration with leadership to identify clinical performance.
- Interviews, hires, mentors, evaluates, coaches and manage performance for a diverse care coordination team.
- Onboards new associates including but not limited all pre-employment human resource tasks, ordering software, hardware, supplies and support technologies.
- Monitors performance of staff including service performance and adherence to established utilization and care coordination benchmarks.
Required Qualifications
- Applicants must reside in the state of Illinois in Cook County, IL, within one of the following ZIP codes, or within a 10-mile radius of these Zip Codes: 60068, 60131, 60171, 60176, 60613, 60614, 60618, 60625, 60626, 60630, 60631, 60633, 60634, 60639, 60640, 60641, 60645, 60646, 60647, 60657, 60659, 60660, 60706, 60707, 60712, 60104, 60130, 60141, 60153, 60155, 60160, 60163, 60164, 60165, 60301, 60302, 60303, 60304, 60402, 60424, 60475, 60513, 60534, 60546, 60601, 60605, 60606, 60607, 60608, 60609, 60610, 60611, 60612, 60615, 60616, 60622, 60623, 60624, 60632, 60642, 60644, 60651, 60653, 60654, 60661, 60680, 60690, 60699, 60804, 60305.
- An active, unrestricted, Registered Nurse (RN) license, Licensed Clinical Social Worker (LCSW) OR Licensed Clinical Professional Counselor (LCPC) in the state of Illinois.
- Five (5) or more years of professional experience working in the health care industry and/or in care management.
- Two (2) or more years of leadership experience..
- Ability to use a variety of electronic information applications/software programs including electronic medical records.
- Proficiency in analyzing and interpreting data trends.
- Ability to travel throughout the state of Illinois.
Preferred Qualifications
- Advanced degree in nursing or business health field.
- Certified Case Manager (CCM).
- Previous experience working in a managed care field.
- Five (5) or more years of previous management/supervisor level experience to include hiring, training, mentoring and coaching associates.
- Prior experience with healthcare quality measures STARS, HEDIS, etc. and/or clinical program monitoring/evaluation.
- Knowledge of community health and social service agencies and additional community resources.
- Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations and assistance. See "Additional Information" section for language assessment information.
Additional Information
- Workstyle: This is a remote position that requires travel.
- Travel: 25% field-based interactions conducting care team oversight visits, meeting with members and/or their families, community partners and other care teams. May need to attend occasional onsite meetings in Humana's Illinois locations.
- Typical Workdays and Hours: Monday - Friday 8:00 AM - 5:00 PM CST. May need to be provide flexibility with work schedule based on business needs.
- Direct Reports: Up to 15 associates.
- Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
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
$94,900 - $130,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.