Humana

Manager, Care Management

Illinois, United States

Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

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.

Responsibilities

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.

Skills

Care Management
Team Leadership
Cross-functional Collaboration
Performance Monitoring
Audit Planning
Clinical Performance Reporting
Mentoring
Coaching
Onboarding
Utilization Management
Discharge Planning

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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