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Humana Healthy Horizons in Virginia is seeking an Associate Director, Care Management (LTSS/ABD) who will lead teams of healthcare professionals responsible for care management. They will lead and guide others in providing integrated services for the clinical teams. The Associate Director, Care Management requires a solid understanding of how organization capabilities interrelate across department(s).

• Manages day-day operation for Long-Term Services and Supports and Aged, Blind or Disabled (LTSS/ABD) clinical care management team.
• Provides ongoing associate coaching and feedback to enhance associate contribution, competency, and performance.
• Oversees the assessment and evaluation of members' 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 wellbeing of members.
• Participates in Care Management collaborative meetings as required by the Virginia Department of Medical Assistance (DMAS)
• Makes decisions related to identifying and resolving complex technical and operational problems within department(s) and leads multiple managers or highly specialized professional associates.
• Monitors data sharing among internal and external resources to ensure service integration, continuity of care, challenges, risk, and opportunities.
• Leads a team that delivers care management services to our members with an agile approach in partnership with technology, provider relations, and other key stakeholders while managing operational risks and contractual/regulatory risks.
• Develops and achieves performance metrics for a fast-paced comprehensive case management environment.
• Assures contractual compliance with mandated and corporate policies regarding other departmental areas such as medical management, utilization management, population health and quality.
• May require cross functional departmental/market collaborations and conducts briefings and area meeting; maintain frequent communication with team members.
• Attracts, develops, empowers, and inspires talent to help Humana Healthy Horizons deliver on their contractual and business strategy.
•  Develops educational and training programs for the LTSS/ABD care management team.
• Collaborates with other Humana leadership to identify the clinical tools and systems to support LTSS Care Management activities.

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.
• Five (5) years of professional experience working with complex populations or in manage care settings.
• Three (3) years of management or supervisory experience.
• 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.

Preferred Qualifications

• Advanced degree in nursing or business-related field.
• Five (5) or more years of professional experience in Care Management, specifically in the delivery of care for elderly or special needs high risk populations such as the Aged, Blind and Disabled (ABD) and those enrolled in Long-Term Services and Supports (LTSS) Waiver Services, in hospice, individuals with developmental disabilities, or have skilled needs and/or in nursing facilities.
• Five (5) or more years of previous management/supervisor level experience.
• Previous experience leading managed care field/remote staff.
• Case Management Certification (CCM).

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