[Remote] Manager, Care Management (Maternal-Child Health) at Humana

Virginia, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Active RN license in the Commonwealth of Virginia, with no disciplinary action
Minimum three (3) years of experience working in the Maternal-Child health field
Minimum two (2) years of MCO management/supervisory experience
Understanding of the Cardinal Care Contract
Experience serving Medicaid, Medicaid/Medicare, TANF, and/or CHIP populations
Previous experience in managing/leading a team
Experience in case management
Proficiency in analyzing and interpreting data trends
Progressive operational leadership experience
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint

Responsibilities

Lead teams of nurses and health professionals responsible for maternal and child services care management
Ensure timely and culturally competent delivery of care, services, and supports in compliance with DMAS requirements and industry best practices
Supervise care management personnel and oversee all care management functions, including assessment, care planning, and care coordination
Lead development of care management policies and procedures to ensure compliance with Commonwealth and federal requirements and incorporate industry best practices
Collaborate with internal departments, providers, and community partners to support the delivery of high-quality case management services
Oversee the processes for comprehensive Member assessments to identify their individual needs
Monitor and maintain staffing levels to meet care and service quality objectives
Support orientation and training of staff
Conduct timely evaluations of direct reports and provide regular opportunities for professional development
Influence and assist corporate leadership in strategic planning to improve effectiveness of care and disease management programs for Maternal-Child health
Participate in Care Management collaborative meetings as required by the Department of Medical Assistance (DMAS)
Collect and analyze performance reports on care management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership
Utilize a holistic, Member-centric approach to engage and motivate Members and their families through recovery and health and wellness programs
Perform clinical intervention through the development of a care plan specific to each Member
Communicate regularly with Members/families, physicians, and facilities/agencies to assure optimal quality patient care and effective operations
Collaborate with relevant internal and external partners to coordinate seamless transitions for Members from inpatient settings to community-based services
Provide ongoing coaching and feedback to enhance contribution, competency, and performance

Skills

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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