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Humana Healthy Horizons in Virginia is seeking an Associate Director, Care Management (Maternal-Child Health) who will lead teams of nurses and health professionals responsible for maternal and child services care management. The Associate Director, Care Management (Maternal-Child Health) 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. They will ensure timely and culturally competent delivery of care, services, and supports in compliance with the Virginia Department of Medical Assistance Services (DMAS) contractual requirements and industry best practices.

• Supervises care management personnel and oversee all care management functions, including assessment, care planning, and care coordination.
• Leads development of care management policies and procedures to ensure compliance with Commonwealth and federal requirements and incorporate industry best practices.
• Collaborates with internal departments, providers, and community partners to support the delivery of high-quality case management services, including introducing innovative approaches to care coordination.
• Oversees the processes for comprehensive Member assessments to identify their individual needs.
• Monitors and maintains staffing levels to meet care and service quality objectives.
• Supports orientation and training of staff.
• Conducts timely evaluations of direct reports and provide regular opportunities for professional development.
• Influences and assists corporate leadership in strategic planning to improve effectiveness of care and disease management programs for Maternal-Child health.
• Participates in Care Management collaborative meetings as required by the Department of Medical Assistance (DMAS)
• 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.
• Performs clinical intervention through the development of a care plan specific to each Member based on clinical judgement, changes in Members’ health or psychosocial wellness, and identified triggers.
• Communicates regularly with Members/families, physicians, and facilities/agencies to assure optimal quality patient care and effective operations.
• Collaborates with relevant internal and external partners to coordinate seamless transitions for Members from inpatient settings to community-based services.
• Provides ongoing coaching and feedback to enhance contribution, competency, and performance.

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).
• Bachelor’s Degree: Bachelor's degree in nursing preferred.
• Active Registered Nurse (RN) License in the Commonwealth of Virginia, with no disciplinary action
• Minimum five (5) years of experience working in healthcare.
• Minimum three (3) years of experience working in the Maternal-Child Health field.
• Minimum two (2) years of management/supervisory experience.
• Experience serving Medicaid, Medicaid/Medicare, TANF, and/or CHIP populations
• Experience in case/care management.
• Proficiency in analyzing and interpreting data trends.
• Progressive business consulting and/or operational leadership experience
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint.
• 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 proof of personal vehicle liability insurance with at least 100/300/100 limits.

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Preferred Qualifications

• Advanced degree in nursing or business-related field
• Previous experience working in a managed care field
• 5 or more years of previous management/supervisor level experience
• Certified Case Manager (CCM)

Additional Information

• Workstyle: This is a remote position that will re