Become a part of our caring community and help us put health first
 

Humana Gold Plus Integrated is seeking a Manager, Care Management, who leads teams of nurses and behavior 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.

               

The Manager, Care Management, supervises, directs, and evaluates a diverse group of health care professionals to assure effectiveness of care coordinators activities. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross-departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department. Key responsibilities include:

• Develop system-view recommendations.
• Report trends.
• Implement appropriate actions to control trends.
• Develop audit plans and tools for teams to ensure compliance with state contract on performance metrics and to ensure member needs are met.
• Develop reporting tools in collaboration with leadership to identify clinical performance.
• Interviewing, hiring, disciplining, evaluating, and mentoring a diverse care coordination work force.
• Onboard new staff including but not limited all pre-employment human resource tasks, ordering of software, hardware, supplies and support technologies.
• Monitor performance of staff including service performance and adherence to establish utilization and care coordination benchmarks.
• Identify members for specific case management and / or disease management activities.
• Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions.
• Requires travel, 50 – 75% of the time.

Use your skills to make an impact
 

Required Qualifications

• Must reside in the Greater Chicago Area or surrounding counties.
• Bachelor’s Degree with an active Registered Nurse (RN) license, Licensed Clinical Professional Counselor, or Master Social Worker with license in state of Illinois without restrictions.
• 5+ years of professional experience.
• 2+ years of leadership experience.
• Prior experience in health care industry/setting and/or case management.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint
• Ability to use a variety of electronic information applications/software programs including electronic medical records.
• Proficiency in analyzing and interpreting data trends.
• Exceptional communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.
• This role is a part of Humana's Driver Safety program and therefore requires and individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits.
• This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

• Advanced degree in nursing or business health field.
• Certified Case Manager (CCM).
• Previous experience working in a managed care field.
• 5 or more years of previous management/supervisor level experience.
• 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.
• Proven ability of critical thinking, organization, written and verbal communication, problem-solving, and analytical skills.

Additional Information

Must reside in the Greater Chicago Area.

Direct Reports: Up to 15 Associates.

Hours