Manager, Care Management (Physical Health)

Humana; District of Columbia; Remote; USD 86,000 - 119,000; Full time

Job summary

Join a forward-thinking company dedicated to health and wellness, where you will lead a team of professionals in managing care for members. This role is pivotal in overseeing assessments and guiding members through their health journeys, ensuring they receive optimal care. You will collaborate across departments, utilize your analytical skills to drive improvements, and engage with members and their families. If you are passionate about making a difference in the lives of others and thrive in a dynamic environment, this opportunity is for you. Embrace the chance to contribute to a mission that prioritizes health and well-being for all.

Benefits

Medical Benefits

Dental Benefits

Vision Benefits

401(k) Retirement Plan

Paid Time Off

Short-term Disability

Long-term Disability

Life Insurance

Paid Parental Leave

Volunteer Time Off

Qualifications

• 3+ years in Care Management, especially for Medicaid/Medicare.
• Active RN or LMHP license required for Virginia.

Responsibilities

• Lead teams in care management for members' physical health.
• Analyze performance reports for process improvement.

Skills

Care Management

Leadership

Data Analysis

Communication Skills

Holistic Member-Centric Approach

Patient Interaction

Coaching and Feedback

Education

Active RN License

Advanced Degree in Nursing

Tools

Microsoft Office

Job description

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

Humana Healthy Horizons in Virginia is seeking a Manager, Care Management (Physical Health) who will lead 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.

• Oversees the assessment and evaluation of members' physical health needs and requirements to achieve and/or maintain an optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and well-being of members.
• Makes decisions related to resources, approach, and tactical operations for projects and initiatives involving own departmental area and requires cross departmental collaboration.
• Conducts briefings, and area meetings, maintains frequent contact with other managers across the department.
• Reviews processes to support contractual guidelines and adjusts accordingly.
• Collects and analyzes performance reports on care management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
• Ability to work independently under general instructions and with a team.
• Utilizes a holistic, Member-centric approach to engage and motivate Members and their families through recovery and health and wellness programs.
• Provides ongoing coaching and feedback to enhance contribution, competency, and performance.
• Maintains knowledge of Medicaid and its covered benefits and services for our membership.

Use your skills to make an impact

Required Qualifications

• Must reside in the Commonwealth of Virginia or within a 40-mile radius from Virginia in a bordering state/district (Washington DC, MD, WV, KY, TN & NC).
• An active, unrestricted Registered Nurse (RN) license or Licensed Mental Health Professional (LMHP) in the Commonwealth of Virginia.
• 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.
• Experience with working with adult and/or Pediatric populations with mild to complex needs.
• Two (2) or more years of management or supervisory experience.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.
• Proficiency in analyzing and interpreting data trends.
• Progressive business consulting and/or operational leadership experience.
• 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.
• Must be able to travel throughout the Commonwealth of Virginia.
• 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.

Preferred Qualifications

• Advanced degree in nursing or related field.
• Three (3) or more years of previous experience working in a managed care field.
• Previous experience in a field based or a homecare-based role.
• Experience with transitions of care model and chronic illnesses.
• Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations and assistance. See "Additional Information" section for information on language assessments.

Additional Information

• Workstyle: This is a remote position that will require you to travel.
• Travel: Up to 25% of the time to Humana Healthy Horizons office in Glen Allen, VA for collaboration and face to face meetings as well as field interactions with providers, members, and their families.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Direct Reports: Up to 15.
• Language Assessment Statement: Any Humana employee who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.