[Remote] Director, Care Management - SC at Humana

Indiana, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Must reside in the state of Indiana
Must meet one of the following: Indiana licensed registered nurse (RN) in good standing with a minimum of three (3) years of management experience OR Master’s level degree with a minimum of three (3) years of management experience OR Bachelor’s level degree in social work, psychology, sociology, counseling, gerontology, or health and human services with a minimum of two (2) years’ full-time direct service experience with the elderly or disabled and a minimum of three (3) years of management experience
Experience with long term services and supports (LTSS) and home and community-based service coordination as it relates to implementing practices to improve social determinants of health
Knowledge about Indiana community resources, and prior experience with the program population and informal caregivers
Proven success in teambuilding and training/coaching staff to meet operational requirements and goals
Comprehensive knowledge of all Microsoft Office applications, specifically, Outlook, Excel, and PowerPoint
Proficiency in analyzing and interpreting clinical and utilization trends
Understanding of health plan and regulatory rules, managed care, care management, disease management and referral processes
Ability to analyze and integrate information and make sound decisions based upon established guidelines
Commitment to the creation of a collaborative and supportive work environment

Responsibilities

Partner with the Care Coordination Leader and other key staff to ensure successful management and excellence in care and service coordination for members
Lead and partner with external organizations providing service coordination to members
Lead, develop, and operationalize LTSS service coordination within Humana's population health strategy, education, and quality improvement activities for the clinical team
Develop, implement, measure, analyze, and report on programs and initiatives designed to improve the health and quality of life of members
Provide input into functions strategy
Lead, mentor, exemplify, and inspire teams responsible for service and transition coordination
Oversee the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members
Make decisions typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implement strategic plans, drive goals and objectives, and improve performance
Encourage professional responsibility and assist with professional development
Define key staff productivity and quality indicators that meet industry standards
Provide input to education and training programs for service and transition coordination teams
Collaborate with other Humana leadership to identify the clinical tools and systems to support care management activities

Skills

Key technologies and capabilities for this role

Care ManagementService CoordinationLTSSPopulation HealthQuality ImprovementTeam LeadershipProgram DevelopmentHealth OutcomesContractual PerformanceClinical Operations

Questions & Answers

Common questions about this position

What are the required qualifications for this Director, Care Management role?

Candidates must reside in Indiana and meet one of these: Indiana licensed RN in good standing with 3+ years management experience, Master’s degree with 3+ years management experience, or Bachelor’s in social work, psychology, sociology, counseling, gerontology, or health/human services with 2+ years full-time direct service experience.

Is this position remote or does it require a specific location?

Candidates must reside in the state of Indiana, indicating an Indiana-based role likely requiring local presence for market oversight.

What is the salary for this position?

This information is not specified in the job description.

What does the team structure look like for this role?

The role leads teams of nurses and behavioral health professionals responsible for care management, providing oversight of the market’s service coordination team.

What makes a strong candidate for this position?

Strong candidates have the required Indiana residency and qualifications like RN licensure or relevant degrees with management or direct service experience, plus skills in leading teams, partnering with external organizations, and driving health outcomes in LTSS service coordination.

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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