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

Humana Healthy Horizons in Virginia is seeking a Manager, Care Management (Physical Health) who will lead 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.

• Oversees the assessment and evaluation of members' physical health needs and requirements to achieve and/or maintain an optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and well-being of members.
• Makes decisions related to resources, approach, and tactical operations for projects and initiatives involving own departmental area and requires cross departmental collaboration.
• Conducts briefings, and area meetings, maintains frequent contact with other managers across the department.
• Reviews processes to support contractual guidelines and adjusts accordingly.
• Collects and analyzes performance reports on care management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
• Ability to work independently under general instructions and with a team.
• Utilizes a holistic, Member-centric approach to engage and motivate Members and their families through recovery and health and wellness programs.
• Provides ongoing coaching and feedback to enhance contribution, competency, and performance.
• Maintains knowledge of Medicaid and its covered benefits and services for our membership.

Use your skills to make an impact
 

Required Qualifications

• Must reside in the Commonwealth of Virginia or within a 40-mile radius from Virginia in a bordering state/district (Washington DC, MD, WV, KY, TN & NC).
• An active, unrestricted Registered Nurse (RN) license or Licensed Mental Health Professional (LMHP) in the Commonwealth of Virginia.
• Three (3) or more years of professional experience in Care Management, specifically in the delivery of care for the physical health needs of members in Medicaid and/or Medicare.
• Experience with working with adult and/or Pediatric populations with mild to complex needs.
• Two (2) or more years of management or supervisory experience.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.
• Proficiency in analyzing and interpreting data trends.
• Progressive business consulting and/or operational leadership experience.
• 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.
• Must be able to travel throughout the Commonwealth of Virginia.
• 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.

Preferred Qualifications

• Advanced degree in nursing or related field.
• Three (3) or more years of previous experience working in a managed care field.
• Previous experience in a field based or a homecare-based role.
• Experience with transitions of care model and chronic illnesses.
• 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 information on language assessments.

Additional Information

• Workstyle: This is a remote position that will require you to travel.
• Travel: Up to 25% of the time to Humana Healthy Horizons office in Glen Allen, VA for collaboration and face to face meetings as well as field interactions with providers, members, and their families.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Direct Reports: Up to 15.
• Language Assessment Statement: Any Humana employee who speaks with a member in a language other than English must take a language proficiency assessment, provided by an o