Sr. Director - PV Case Management ICSR
Eli Lilly and CompanyFull Time
Expert & Leadership (9+ years)
Must reside in Illinois and possess an active, unrestricted Registered Nurse (RN) license, Licensed Clinical Social Worker (LCSW), or Licensed Clinical Professional Counselor (LCPC) in Illinois. Requires five or more years of experience in the healthcare industry or care management, with at least two years in a leadership role. Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and various electronic health record applications is necessary. Must be able to travel within Illinois, have a valid state driver's license, and maintain required vehicle insurance. Experience with healthcare quality measures like STARS and HEDIS, and knowledge of community health resources are preferred. Bilingual skills in Spanish, Arabic, Vietnamese, Amharic, Urdu, or other languages are a plus.
Managers of Care Management will lead teams of nurses, care coordinators, and behavioral health professionals responsible for care management. They will supervise, direct, and evaluate healthcare professionals to ensure effective care coordination, and lead cross-functional collaboration through regular briefings and meetings. Responsibilities include identifying members for case management, monitoring activities like post-discharge calls and pre-assessments, and developing system-view recommendations and reports to control trends. They will also develop audit plans and tools for compliance, create reporting tools to identify clinical performance, and manage staff performance, including hiring, training, mentoring, and coaching. Onboarding new associates and monitoring staff performance against benchmarks are also key duties.
Health insurance provider for seniors and military
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.