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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, transitions of care and child/adolescent populations. 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.

Use your skills to make an impact
 

Required Qualifications

• An active, unrestricted, Licensed Clinical Social Worker (LCSW) OR Licensed Clinical Professional Counselor (LCPC) in the state of Illinois. License must be active within 6 months of being hired.
• Experience with children, adolescence and foster care population
• 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 up to 25%

Preferred Qualifications

• Advanced degree in nursing, social services, psychology or business health field.
• 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.

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

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.

 

$86,300 - $118,700 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. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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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.