The Manager, Care Management 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, direct and evaluate 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.
- 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
- Associate's Degree
- Active Registered Nurse (RN) license or Social Work (SW) license
- 5 or more years of professional experience
- 2 or more years of management experience
- Proficiency in analyzing and interpreting data trends.
- Progressive business consulting and/or operational leadership experience
Preferred Qualifications
- Bachelor's degree or advanced degree in nursing or business health field
- Previous experience working in a managed care field
- 5 or more years of previous management/supervisor level experience
Additional Information
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.
Work at Home Requirements
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$86,300 - $118,700 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
