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 oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and well-being of members.
- 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.
- This role requires travel within Region 3 (Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union, FL).
The Manager, Care Management shall meet one of the following qualifications:
- Master's Degree in human services, social sciences, or health related field with at least 2 years of case management experience with at least 1 year focused on elderly or disabled population.
- Bachelor's Degree in a health related field with at least 5 years of case management experience with at least 1 year focused on the elderly or disabled population.
- 9 years of professional human service experience with a minimum of 5 years of case management experience with at least 1 year focused on the elderly or disabled population.
The Manager, Care Management shall meet all of the following qualifications:
- All Registered Nurses (RN) or Licensed Practical Nurses(LPN) must be licensed in the state of Florida without restrictions.
- 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 100,000/300,000/100,000 limits.
- Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work.
- Must have accessibility to high speed DSL or Cable modem for a home office (No Satellite).
- Intermediate to advanced computer skills and experience with Microsoft Word, Excel and Outlook.
- This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
- AHCA Fingerprint Required.
- Previous leadership experience.
- BSN or Bachelor’s degree in a related field.
- Health Plan experience.
- Previous Medicare/Medicaid experience.
- Call center or triage experience.
- Previous experience in utilization management, discharge planning and/or home health or rehab.
- Prior nursing home diversion or long term care case management experience.
- Experience with health promotion, coaching and wellness.
- Experience working with the geriatric population.
- Bilingual a plus.