Manager, Care Management

Manager, Care Management

Become a part of our caring community and help us put health first. Humana Gold Plus Integrated is looking for Managers of Care Management who will lead teams of nurses, care coordinators and behavioral 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. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. The Manager, Care Management supervises, directs and evaluates a diverse group of health care professionals to assure effectiveness of care coordination activities. Leads cross-functional collaboration through regular briefings and area meetings; maintains ongoing communication with departmental managers to ensure alignment and operational efficiency. Identify members for specific case management and / or disease management activities. Monitors case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions. Develop system-view recommendations, reports trends and implement appropriate actions to control trends. Develop audit plans and tools for teams to ensure compliance with state contracts on performance metrics and to ensure member needs are met. Develop reporting tools in collaboration with leadership to identify clinical performance. Interviews, hires, mentors, evaluates, coaches and manages performance for a diverse care coordination team. Onboards new associates including but not limited all pre-employment human resource tasks, ordering software, hardware, supplies and support technologies. Monitors performance of staff including service performance and adherence to established utilization and care coordination benchmarks.

Required Qualifications :

• Must reside in the state of Illinois.
• An active, unrestricted, Registered Nurse (RN) license, Licensed Clinical Social Worker (LCSW) OR Licensed Clinical Professional Counselor (LCPC) in the state of Illinois.
• Five (5) or more years of professional experience working in the health care industry and / or in care management.
• Two (2) or more years of leadership experience.
• Comprehensive knowledge of all Microsoft Office applications, specifically Word, Excel, and PowerPoint.
• Ability to use a variety of electronic information applications / software programs including electronic medical records.
• Proficiency in analyzing and interpreting data trends.
• 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.
• Ability to travel throughout the state of Illinois.
• 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. Individuals 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.

Preferred Qualifications :

Additional Information :

Scheduled Weekly Hours : 40

Pay Range : $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.

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Humana Inc. (NYSE : HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services.