Care Management Leader

2 weeks ago


Nashville, Tennessee, United States Humana, Inc. Full time
About the Role

We are seeking a highly skilled and experienced Care Management Leader to join our team at Humana, Inc. As a key member of our care management team, you will be responsible for leading teams of nurses and healthcare professionals in providing high-quality care to our members.

Key Responsibilities
  • Lead Care Management Teams: Oversee the assessment and evaluation of members' physical health needs and requirements to achieve and/or maintain an optimal wellness state.
  • Make Strategic Decisions: Make decisions related to resources, approach, and tactical operations for projects and initiatives involving own departmental area and requiring cross-departmental collaboration.
  • Conduct Briefings and Meetings: Conduct briefings and area meetings, maintaining frequent contact with other managers across the department.
  • Review and Adjust Processes: Review processes to support contractual guidelines and adjust accordingly.
  • Monitor Performance: Collect and analyze performance reports on care management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
  • Work Independently and Collaboratively: Ability to work independently under general instructions and with a team.
  • Member-Centric Approach: Utilize a holistic, member-centric approach to engage and motivate members and their families through recovery and health and wellness programs.
  • Provide Coaching and Feedback: Provide ongoing coaching and feedback to enhance contribution, competency, and performance.
  • Stay Up-to-Date on Medicaid and Benefits: Maintain knowledge of Medicaid and its covered benefits and services for our membership.
Requirements
  • Residency: Must reside in the commonwealth of Virginia or within a 40-mile radius from Virginia in a bordering state/district.
  • License: An active, unrestricted Registered Nurse (RN) license or Licensed Mental Health Professional (LMHP) in the Commonwealth of Virginia.
  • Experience: Three (3) or more years of professional experience in Care Management, specifically in the delivery of care for the physical health needs of members in Medicaid and/or Medicare.
  • Population Experience: Experience working with adult and/or pediatric populations with mild to complex needs.
  • Management Experience: Two (2) or more years of management or supervisory experience.
  • Technical Skills: Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.
  • Data Analysis: Proficiency in analyzing and interpreting data trends.
  • Business Consulting and Leadership: Progressive business consulting and/or operational leadership experience.
Preferred Qualifications
  • Advanced Degree: Advanced degree in nursing or related field.
  • Managed Care Experience: Three (3) or more years of previous experience working in a managed care field.
  • Field-Based Experience: Previous experience in a field-based or homecare-based role.
  • Transitions of Care Experience: Experience with transitions of care model and chronic illnesses.
  • Bilingual or Multilingual: 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.


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