Manager, Care Management

Humana Inc; League City (TX); Remote; USD 86,000 - 119,000; Full time

Job summary

Join Humana Inc. as a Manager in Care Management, overseeing a team to ensure high-quality patient care. This role focuses on compliance with regulatory standards while leading the team in improving health outcomes. Candidates should possess a strong background in healthcare management and case management certification.

Qualifications

• 5 years of healthcare supervisory/management experience required.
• Experience in healthcare operations with stringent performance and government compliance.
• 1 - 3 years of case management leadership experience preferred.

Responsibilities

• Lead and develop case management teams to improve operational results.
• Ensure compliance with government and contractual requirements.
• Monitor team performance and develop training programs.

Skills

Healthcare supervisory experience

Regulatory compliance

Leadership

Performance measurement

Education

Current valid and unrestricted Registered Nurse license

Certified Case Manager (CCM)

BSN

Job description

Job Profile

Manager, Care Management

Job Level

Manager

Become a part of our caring community and help us put health first

Reports directly to the Director, Case Management and supports the strategic priorities for Clinical Operations, Medical & Behavioral Health and Humana Government Business (HGB). Leads clinical functions related to as it specifically relates to Case Management programs and support for beneficiaries in the TRICARE East.

Coordinates, assesses, and monitors coordination of Case Management program activities, ensuring maximum quality, benefits, and effectiveness for beneficiaries. Monitors Case Management team workload and engagement performance. Coaches Case Management team as needed to achieve Government performance standards. Keeps the Director, Case Management apprised of progress and issues within their area of responsibility. Performs all duties within the scope of her/his role requirements. Will coordinate as needed with members of Case Management team on cases with support needs. Ensures regulatory compliance by aligning care management policies, procedures, and processes to maintain TRICARE contractual standards, improve clinical outcomes and support associate engagement; collects and analyzes individual and team data to determine operational efficiency and effectiveness. Responsible for hiring, coaching, leading, and managing performance for up to 16 associates.

KEY ACCOUNTABILITIES

• Lead and develop direct reports by articulating strategic, operational and tactical goals to focus on consistent execution of Care Management processes and ensure teams meet their goal; escalates critical challenges and/or issues to reporting leader. Develops action plans to improve operational results.

• Ensures development and implementation of operational goals, training programs, policies and procedures and quality improvement projects related to Care Management programs and support. Identifies training needs, leads, develops and participates in staff training.

• Ensures implementation of monitoring systems and measurements related to Care Management program support initiatives to maintain focus on performance goals and standards, quality and compliance measures with development of action plans to improve results.

• Ensures compliance with Government and contractual requirements related to Care Management program support and initiatives by maintaining a working relationship with the government customer and other HGB departments. Interfaces with quality management and clinical operations programs ensuring beneficiary coordination of care.

• Ensures processes and procedures are in place and applied consistently to maintain appropriate accreditation and certifications related to Care Management program and support.

• Performs team analysis, identifies insights, process gaps, variation and non-value-added tasks; works closely with leaders to implement strategies focused on maximizing performance and health outcomes. Provides input for process validation to re-think routine, ensure simplicity and streamline health solutions.

• Special projects as assigned by the Clinical Operations Leadership.

Use your skills to make an impact

Required Qualifications

• Our Department of Defense Contract requires U.S. citizenship for this position

• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)

• HGB is not authorized to do work in Puerto Rico per our government contract.We are not able to hire candidates that are currently living in Puerto Rico.

• Current valid and unrestricted Registered Nurse license

• Certified Case Manager (CCM)

• 5 years of healthcare supervisory/management experience, including regulatory compliance experience

Experience in healthcare operations with stringent performance & government compliance requirements

Preferred Qualifications

• 1 - 3 years of case management leadership experience and previous success in project and program management

• BSN

• TRICARE experience

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• 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 yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Referral Bonus Information

This requisition is not eligible for a referral bonus.

About us

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.