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

Virginia, United States

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Not SpecifiedCompensation

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

Full TimeJob Type

UnknownVisa

Healthcare, Medicaid Managed CareIndustries

Requirements

Must reside in the Commonwealth of Virginia
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
Preferred Qualifications
BSN or an advanced degree in nursing or business-related field
Certified Case Manager (CCM)
Previous MCO management experience

Responsibilities

Lead teams of nurses and health professionals responsible for maternal and child services care management
Work within specific guidelines and procedures; apply advanced technical knowledge to solve moderately complex problems; receive assignments in the form of objectives and determine approach, resources, schedules, and goals
Ensure timely and culturally competent delivery of care, services, and supports in compliance with Virginia Department of Medical Assistance Services (DMAS) contractual 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, including introducing innovative approaches to care coordination
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
Work independently under general instructions and with a team
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 based on clinical judgement, changes in Members’ health or psychosocial wellness, and identified triggers
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

Key technologies and capabilities for this role

Care ManagementMaternal-Child HealthTeam LeadershipCare PlanningCare CoordinationStaff SupervisionPolicy DevelopmentCompliance ManagementPerformance AnalysisStrategic PlanningStaff TrainingStakeholder Collaboration

Questions & Answers

Common questions about this position

Is there a hiring bonus for this position?

Yes, there is a $5,000 hiring bonus, with $2,000 paid after 6 months (180 days) of employment.

What is the employment type for this role?

This is a full-time position.

What are the key responsibilities of this manager role?

The role involves supervising care management personnel, overseeing assessment, care planning, and coordination, leading policy development for compliance, collaborating with partners, monitoring staffing, supporting training, and analyzing performance reports.

What is the team structure like in this role?

The manager leads teams of nurses and health professionals responsible for maternal and child services care management, supervises care management personnel, monitors staffing levels, supports orientation and training, and conducts evaluations of direct reports.

What makes a strong candidate for this position?

Strong candidates should have advanced technical knowledge to solve moderately complex problems, ability to work independently under general instructions and with a team, clinical judgement for care planning, and experience in maternal-child health care management with a holistic, member-centric approach.

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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