[Remote] Associate Director, Care Management at Humana

Illinois, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Managed CareIndustries

Requirements

Must reside in the state of Illinois, Indiana or Wisconsin
An active, unrestricted, Registered Nurse (RN) license, Licensed Clinical Social Worker (LCSW) OR Licensed Clinical Professional Counselor (LCPC) in the state of Illinois
Six (6) or more years of professional experience working in the health care or managed care industry
Three (3) or more years’ experience working for a managed care health plan
Minimum of two (2) years of experience in a leadership role managing other leaders or supervisors
Three (3) or more years’ experience leading care coordination teams to drive measurable outcomes across diverse member populations
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
Must be able to travel in the state of Illinois to provider offices, Illinois Department of Healthcare and Family Services (HFS) and Centers for Medicare & Medicaid Services (CMS) and Humana’s Illinois locations
Patient facing role and required to be screened for TB

Responsibilities

Lead teams of nurses and behavior health professionals responsible for care management
Oversee the assessment and evaluation of members’ needs and requirements to achieve and/or maintain an optimal wellness state
Guide the development, implementation, and evaluation of care management programs to align organizational objectives and regulatory requirements
Lead multiple managers or highly specialized professional associates
Monitor data sharing among internal and external resources to ensure service integration, continuity of care, challenges, risk, and opportunities
Facilitate effective communication and collaboration with internal and external stakeholders, including providers, payers, and regulatory agencies
Lead the preparation and presentation of program reports, utilizing data analytics to monitor performance, identify trends, and recommend improvements
Champion initiatives for process improvement and innovation to advance care management practices and outcomes

Skills

Care Management

Data Analytics

Process Improvement

Communication

Collaboration

Program Development

Needs Assessment

Wellness

Risk Management

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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