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Humana Healthy Horizons in Virginia is seeking a Manager, Care Management (LTSS-ABD) who will lead a team of nurses and behavior health professionals responsible for care management of members, specifically the elderly or special needs populations such as the Aged, Blind and Disabled (ABD), those enrolled in Long-Term Services and Supports (LTSS) Waiver Services, in hospice and/or in nursing facilities. They will lead LTSS-ABD care management operations and staff to ensure timely and culturally competent delivery of care services and support compliance with contractual requirements and industry best practices.
The Manager, Care Management (LTSS-ABD) 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 care management personnel and care management functions, including assessment, care planning activities, and care coordination to ensure members/families maintain an optimal wellness state.
• Develops care management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
• Conducts briefings, and area meetings, maintains frequent contact with other managers across the department.
• Collaborates with internal and external providers or departments to meet the member’s needs.
• Oversees staff training, evaluation, and performance monitoring.
• Supports the Director/Leadership in meeting the goals of department/market.
• Monitors and maintain staffing levels to meet care and service quality objectives.
• Makes decisions related to resources, approach, and tactical operations for projects and initiatives involving own departmental area and requires cross departmental collaboration.

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 working with complex populations or in manage care settings.
• 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.
• Exceptional oral and written communication and interpersonal skills with the ability to quickly build rapport.
• 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

• Three (3) or more years of professional experience in Case Management, in Medicaid and/or Medicare, specifically in the delivery of care for elderly or special needs populations such as the Aged, Blind and Disabled (ABD) and those enrolled in Long-Term Services and Supports (LTSS) Waiver Services, in hospice and/or in nursing facilities.
• Previous experience in a field based or a homecare-based role.
• Master's degree in human services, social sciences, or health related field.
• Previous experience in utilization management, discharge planning and/or home health or rehabilitation.
• Experience with health promotion, coaching and wellness.
• Care Management certification (CCM). 
• Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations or assistance. See Additional Information on testing.

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 Repo