Humana

Director of Care Management

Illinois, United States

Humana Logo
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

Candidates must possess a Bachelor’s degree and hold a clinical license such as RN, LCSW, or LCPC, along with a minimum of 8 years of clinical experience encompassing Utilization Management and Case Management, and at least 5 years of direct management experience. Furthermore, they should have 5 years of experience working with DSNP and Medicare programs, and 2 years of project leadership experience, and must reside in or be willing to relocate to the State of Illinois.

Responsibilities

The Director of Care Management will lead and nurture teams including Care Coordination, Care Navigation, Case Management, Transition Coordination, Service Coordination, HRSN, and support teams, fostering diversity and inclusion, and providing training and advancement opportunities. They will oversee departmental post-award activities, develop and implement strategies to support Members’ goals for aging at home, and collaborate with plan leadership on process improvements and operational efficiencies. The Director will ensure compliance with contract, CMS, and HFS policies, oversee data sharing for whole-person care, and foster relationships with stakeholders. They will manage departmental budget, participate in collaborative meetings, review data to identify care gaps, and implement solutions to address these areas.

Skills

Care Management
Leadership
Clinical Knowledge
Communication Skills
Critical Thinking
Strategic Planning
Team Development
Healthcare Operations
Medicaid and Medicare Regulations
Cultural and Linguistic Competency

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.

Key Metrics

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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